CTICasesEsophageal Pulsion Diverticulum
Imaging findings
Chest radiograph shows a large retrocardiac air-fluid level. CT and barium swallow study show a massive pulsion diverticulum of the esophagus causing compression of the adjacent esophagus and airway. Severe aspiration is demonstrated on the swallow study, with contrast tracking into the left mainstem bronchus.
Key takeaways
Esophageal diverticula can be pulsion (associated with esophageal dysmotility and increased intraluminal pressure) or traction (associated with adjacent mediastinal scarring). A large diverticulum can retain food and fluid, presenting as a retrocardiac air-fluid level, and poses a high risk of recurrent aspiration pneumonia.
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