case_images: PMC3656691_01
case_images: a Pharyngoesophagography showed a large diverticulum retaining a meal rest (black arrows). Ultrasonography showed a hypoechoic lesion containing echogenic foci (white arrows) suggesting a meal rest in the right lobe of the thyroid (b) and a hypoechoic lesion containing some small hyperechoic foci suggesting air bubbles (white arrowheads) in the left lobe of the thyroid (c). d Ultrasonography showed an isoechoic mass measuring 30.6 x 16.7 mm (black arrowheads) containing hyperechoic foci suggesting calcification in the left lobe of the thyroid.
case_images: crg-0007-0188-g01.jpg
case_images: PMC3656691_01_crg-0007-0188-g01.jpg
case_images: F1
case_images: Pharyngoesophagography showed a large diverticulum retaining a meal rest at the pharyngoesophageal junction (fig. 1a). Ultrasonography showed a hypoechoic lesion containing echogenic foci that were suggestive of a meal rest in the posterior bilateral lobe of the thyroid (fig. 1b, c), and showed an isoechoic mass measuring 30.6 x 16.7 mm in the left lobe of the thyroid (fig. 1d).
case_images: Cervical CT findings. a Coronal CT showed the bilateral hypopharyngeal diverticula (white arrows) protruding from the cervical esophagus laterally; the cervical nodule (white arrowheads) was located under the left diverticulum. b Coronal CT showed that the left-sided hypopharyngeal diverticulum (white arrows) was located below the cricoid cartilage (black arrow). c Axial CT showed that the thyroid tumor (white arrows) contained an isodensity area with a hyperdensity area that was suggestive of calcium deposition.
case_images: crg-0007-0188-g02.jpg
case_images: PMC3656691_01_crg-0007-0188-g02.jpg
case_images: F2
case_images: Cervical computed tomography (CT) showed a thyroid nodule and bilateral hypopharyngeal diverticula (fig. 2a). The hypopharyngeal diverticula arose bilaterally from the cervical esophagus and were located just below the cricoid cartilage (fig. 2b). The thyroid nodule was noted to contain an isodensity area with a hyperdensity area that was suggestive of calcium deposition (fig. 2c).
case_images: Pharyngoesophagographic findings. a A large left-sided diverticulum and a small right-sided diverticulum were shown in the pharyngoesophageal junction and the thyroid tumor was pressing on the left-sided diverticulum and the cervical esophagus (black arrows) on the frontal projection. b A left-sided diverticulum was shown overlapping the anterior wall of the cervical esophagus in the lateral position. c Intraoperative view of the left side of the neck showed a left-sided hypopharyngeal diverticulum sac above the upper esophageal longitudinal muscle fibers (black arrows) that was mobilized from the left lobe of the thyroid and the thyroid tumor. d Schema of the posterior view of the hypopharynx and cervical esophagus. Zenker's diverticulum projects to the posterior wall of the esophagus between the inferior constrictor muscle and the cricopharyngeal muscle. The orifice is known as Killian's triangle. Killian-Jamieson diverticulum projects to the lateral wall of the esophagus between cricopharyngeal muscle and upper esophageal longitudinal muscle. The orifice is called Killian-Jamieson triangle.
case_images: crg-0007-0188-g03.jpg
case_images: PMC3656691_01_crg-0007-0188-g03.jpg
case_images: F3
case_images: A barium swallow pharyngoesophagogram showed a large left-sided diverticulum 4 cm in diameter and a small right-sided diverticulum 1.5 cm in diameter of the pharyngoesophageal junction in the frontal position (fig. 3a), and showed the left-sided diverticulum overlapping the anterior wall of the cervical esophagus in the lateral position (fig. 3b). The left-sided diverticulum above the upper esophageal longitudinal muscle was mobilized from the left lobe of the thyroid and the thyroid tumor (fig. 3c), taking care not to injure the recurrent laryngeal nerve, which runs in the tracheoesophageal groove.