CTICasesEsophageal Traction Diverticulum Secondary to Histoplasmosis
Imaging findings
Chest radiographs and a double-contrast esophagram demonstrate a calcified subcarinal mass with a localized outpouching of the lower esophagus that fills with contrast and air. Chest CT confirms the presence of a heavily calcified subcarinal lymph node matted against and pulling on the wall of the adjacent esophagus. Splenic calcifications are also noted on the upper abdominal sections of the CT scan.
Key takeaways
Esophageal traction diverticula are classically described in the setting of tuberculosis but can also arise from mediastinal histoplasmosis. Chronic granulomatous inflammation and subsequent calcification of subcarinal lymph nodes lead to localized fibrous adhesion and mechanical pulling on the esophageal wall, creating a true diverticulum that rarely requires surgical intervention unless dysphagia is severe.
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