Zenker's diverticulum: The Daily PANCE Blueprint
A 68-year-old man presents to the clinic with complaints of dysphagia, regurgitation of undigested food, and a sensation of a lump in his throat for the past several months. He also mentions occasional coughing and bad breath. His medical history is significant for hypertension and hyperlipidemia. On examination, there is no palpable mass in the neck, and the oropharyngeal examination is unremarkable. A barium swallow study reveals a pouch-like structure arising from the posterior hypopharynx. Which of the following is the most likely diagnosis?
A. Achalasia
B. Esophageal cancer
C. Zenker's diverticulum
D. Esophageal stricture
E. Cricopharyngeal bar
Answer and topic summary
The answer is C. Zenker’s diverticulum
The patient’s symptoms of dysphagia, regurgitation of undigested food, halitosis (bad breath), and the finding of a pouch-like structure on a barium swallow study are characteristic of Zenker’s diverticulum. Zenker’s diverticulum is a false diverticulum that arises from the posterior hypopharynx due to increased hypopharyngeal pressure and weakness at Killian’s triangle.
Incorrect Answer Explanations:
- A. Achalasia is characterized by dysphagia for solids and liquids, regurgitation of food, and weight loss. A barium swallow in achalasia typically shows a dilated esophagus with a bird-beak appearance at the lower esophageal sphincter, not a pouch-like structure.
- B. Esophageal cancer often presents with progressive dysphagia (initially for solids, then liquids), significant weight loss, and potentially a palpable mass in advanced stages. A barium swallow may show an irregular narrowing or mass, but not a diverticulum.
- D. Esophageal stricture typically presents with progressive dysphagia for solids, and it is often associated with a history of gastroesophageal reflux disease (GERD). A barium swallow would show a narrowed segment of the esophagus, not a diverticulum.
- E. Cricopharyngeal bar is a structural abnormality resulting from hypertrophy or spasm of the cricopharyngeus muscle, leading to dysphagia. It would appear as a horizontal bar or indentation on a barium swallow, not as a pouch-like structure.
View blueprint lesson
Smarty PANCE Content Blueprint Review:
Covered under ⇒ PANCE Blueprint GI and Nutrition ⇒ ⇒
