Sonographic diagnosis features of Zenker diverticulum

The purpose of this study was to analyze the image of the lesion and give the sonographic diagnosis features of Zenker diverticulum.

Sonography was performed with a high-frequency linear array probe. The location, size, shape, and echogenicity of the Zenker diverticulum were recorded. To find the lesion whether to be connected with the adjacent esophageal wall. During compressing with a probe, to detect the changes of the lesion shape and echogenicity. As swallowing or drinking water, to detect the fluid whether to enter into the lesions. All patients were given barium swallow test.

All nine Zenker diverticulum were all located at the posterolateral aspect of the left lobe. The long diameters of all Zenker diverticulum measured by sonography ranged from 9.6mm to 45 mm (average 16.4±11 mm). There were four types of sonogram features of Zenker diverticulum in our study: (1) The lesion was isoechoic mass with boundary hypoechoic rim and internal small, punctuate, echogenic foci. (2) The lesion contained a central hyperechoic area associated with a comet-tail artifact. (3) The lesion was hyperechoic and heterogeneous, with stronger echoes anteriorly, but there was no acoustic shadowing or reverberation artifacts. (4) The lesion was oval-shaped mixed nodule, with unclear border and relatively multiple punctuate strong echoes. During the patient's ingestion of water, an increase in the lesion's size, a reduction in the definition of the margins, and heterogeneous echogenicity of the lesion's contents are observed. Barium-swallow images of the upper esophagus demonstrate an out-pouching at the posterior aspect of the pharyngoesophageal junction.

The sign of air in the Zenker diverticulum is the most important sonographic feature for differential diagnosis from thyroid nodules. It was useful to diagnosis and prevents patients from invasive procedure such as aspiration and unnecessary operation.