Presentation
Our patient presented with acute symptoms of pain and vomiting and later developed dysphagia. [thoracicmedicine.org]
Presenting symptoms of Epiphrenic esophageal diverticula depends on the underlying disease process and they mostly present with alarming symptoms. [omicsonline.org]
TEDs usually present with dysphagia or recurrent aspiration. We describe here a rare presentation of upper gastro-intestinal bleeding resulting from ulceration and fistulization of the TED. [springerplus.springeropen.com]
Giant cell formation is rare, but fused histiocytes are present. [acgcasereports.gi.org]
TED usually presents with symptoms such as dysphagia, postural regurgitation, belching, retrosternal pain, heartburn, and epigastric pain. [ncbi.nlm.nih.gov]
Gastrointestinal
- Dysphagia
Our patient presented with acute symptoms of pain and vomiting and later developed dysphagia. [thoracicmedicine.org]
Esophagram for Patient 2, 75-year-old woman with regurgitation, dysphagia, pain, and odynophagia. Figure 2. Esophagram for Patient 2, 75-year-old woman with regurgitation, dysphagia, pain, and odynophagia. Figure 3. [jaoa.org]
[…] esophagus Cause of Zenker's diverticulum and pulsion diverticula ↑ pressure during swallowing Location of Zenker's diverticulum Between cricopharyngeus (UES) and thyropharyngeus portion of inferior pharyngeal constrictors SSx of Zenker's diverticulum Dysphagia [quizlet.com]
Clinicians should be aware of the possibility of traction mid-esophageal diverticulum in sarcoidosis patients with progressive dysphagia. [acgcasereports.gi.org]
- Regurgitation of Undigested Food
Zenker's diverticula are often found in older patients who present with dysphagia, regurgitation of undigested food, choking, hoarseness, halitosis or even a neck mass. [med-ed.virginia.edu]
[…] of undigested food, dysphagia Tx for Traction diverticulum Excision w 1° closure, palliative XRT if 2/2 invasive CA Location of epiphrenic diverticulum Cause of epiphrenic diverticulum SSx of epiphrenic diverticulum ASx, dysphagia, regurgitation Dx of [quizlet.com]
Patients complain of regurgitation of undigested food in to the mouth. [explainmedicine.com]
Usually true diverticulum Common site: the middle esophagus References: [1] [2] [5] [3] Clinical features Clinical presentation depends on diverticulum size and localization Dysphagia (most common) Regurgitation of undigested food Aspiration Coughing [amboss.com]
Patients present with upper esophageal dysphagia, regurgitation of undigested food, aspiration, noisy deglutition, halitosis, and changes in voice. Mild-to-moderate weight loss is frequent. [gastrointestinalatlas.com]
- Odynophagia
Esophagram for Patient 2, 75-year-old woman with regurgitation, dysphagia, pain, and odynophagia. Figure 2. Esophagram for Patient 2, 75-year-old woman with regurgitation, dysphagia, pain, and odynophagia. Figure 3. [jaoa.org]
(eg: Zenker’s diverticulum) can cause dysphagia and odynophagia. [2] Regurgitation Patients complain of regurgitation of undigested food in to the mouth. [explainmedicine.com]
He denied any fevers, unintentional weight loss, hemoptysis, sore throat, odynophagia, shortness of breath, or wheezing. On examination he was hemodynamically stable. Chest exam revealed lower left lung crackles. [acgcasereports.gi.org]
SIGNS AND SYMPTOMS Mucosal injury may be asymptomatic or may manifest by dysphagia, odynophagia or chest pain. [clevelandclinicmeded.com]
Esophagitis Symptoms of esophagitis Symptoms include dysphagia, odynophagia, and retrosternal pain. Infectious esophagitis A severe general disease can be accompanied by esophagitis. [lecturio.com]
- Epigastric Tenderness
Per abdominal examination revealed epigastric tenderness with a vague mass. Hemogram was normal. ESR was 22 mm at the end of the first hour. Mantoux test was negative. [thoracicmedicine.org]
Workup
X-Ray
- Pericardial Effusion
effusion 168 Case 64 Pericardial cysts 170 Case 65 Partial or complete absence of the pericardium 172 Case 66 Pleural lipoma 176 Case 67 Prominent subpleural fat with chronic pleural disease 178 Case 68 Benign fibrous tumor of the pleura + pedicles 180 [books.google.com]
Treatment
Significant updates on bariatric surgery, Barrett's esophagus, endoscopic ultrasound, endosonography, treatment of liver disease, and much more keep you current on the latest advances. [books.google.com]
Majority of the patients respond well to antitubercular treatment. Our patient was stable and hence he was started on four-drug antitubercular treatment, to which he responded very well. [thoracicmedicine.org]
[…] typically associated with mediastinal granulomatous disease (TB, histoplasmosis) • They are usually small with a blunt tapered tip that points upward • These are usually an incidental finding on barium swallow • They rarely cause symptoms or require treatment [docsity.com]
Treatment mostly requires for the underlying disease condition like achalasia [ 8 ]. Treatment for EED includes oesophageal myotomy, diverticulectomy, and fundoplication [ 3 ]. [omicsonline.org]
TREATMENT AND OUTCOMES Symptomatic Zenker's diverticula can be treated by surgical excision. Newer treatments are applied endoscopically. [clevelandclinicmeded.com]
Prognosis
[…] mid esophagus at level of tracheal bifurcation; becoming uncommon; previously mostly due to tuberculosis, mediastinal lymphadenitis and scarring; may be due to motor dysfunction, congenital or alkali ingestion ( Med Hypotheses 2004;62:931 ); better prognosis [pathologyoutlines.com]
Treatment and Prognosis Patients with small asymptomatic or minimally symptomatic diverticula can be followed, because progressive enlargement is uncommon. 2 Patients with large and symptomatic Zenker’s diverticula should be offered treatment. [clinicalgate.com]
Even in adenocarcinoma which is less sensitive to chemo and radiotherapy, combined treatment improves prognosis. [clevelandclinicmeded.com]
Prognosis and Patient Counseling. Both surgical and endoscopic modalities have high success rates for symptom improvement (>90%). Surgical intervention does have an associated perioperative mortality of approximately 1.8%. [clinicaladvisor.com]
Overall, prognosis is rather bad since the first noticeable symptom of the disease, dysphagia, is a late symptom already. At the time the diagnosis is made, for 95 % of the tumors, palliative treatment is the only treatment option left. [lecturio.com]
Etiology
The possibility of a secondary motor disorder in the etiology of the diverticulum must be considered in these circumstances. [hon.ch]
Importance Diverticula of the thoracic esophagus are classified by their location and their etiology [2]. Traction diverticula typically arise in the mid esophagus. [mayoclinic.pure.elsevier.com]
They are categorized primarily by anatomic location and etiology into pulsion and traction diverticula. [ctsnet.org]
Each has a distinct etiology. The pulsion type is the most common form in the United States. [mhmedical.com]
Tuberculosis and histoplasmosis are known etiologies of this condition. 2 Figure 2. Lung biopsy showing dense fibrosis encasing hard granulomata composed of epithelioid histiocytes. [acgcasereports.gi.org]
Epidemiology
Epidemiology Rare diverticula compared to other gastrointestinal sites (prompting < 1% of all barium swallows and accounting for < 5% of all cases of dysphagia ). [amboss.com]
An excellent, up-to-date review of the epidemiology, etiology, clinical presentations, diagnosis, and management of esophageal diverticula. PubMed CrossRef Google Scholar 3. Jordan PH, Kinner BM: New look at epiphrenic diverticula. [link.springer.com]
Epidemiology Age Most esophageal diverticula occur in middle-aged adults and elderly people. Presentation in infants and children is rarely seen. [emedicine.medscape.com]
While there are differences between squamous cell carcinoma and adenocarcinoma in epidemiology, location and patterns of spread, both diseases tend to spread early outside the esophagus and both share a rather poor prognosis unless discovered early. [clevelandclinicmeded.com]
Pathophysiology
Pathophysiology (see “Pathophysiology” below) Pulsion Diverticula Traction Diverticula References: [1] [2] [4] [3] Pathophysiology Anatomy 3 constrictions of the esophagus The cervical constriction: beginning of the esophagus (upper esophageal opening [amboss.com]
Pathophysiology Esophageal diverticula are classified by location in the esophagus. Upper (pharyngoesophageal, Killian-Jamieson, or Zenker), middle, or lower (epiphrenic). [emedicine.medscape.com]
PATHOPHYSIOLOGY Virtually all mucosal injuries are accompanied by inflammation with various degrees of severity including from erythema, frank ulcers with potential scarring and bleeding and strictures. [clevelandclinicmeded.com]
In addition, they may be categorized by their pathophysiology as pulsion or traction types of diverticula. [aibolita.com]
Prevention
Endoscopy may be helpful in evaluating associated conditions, but must be performed with extreme caution to prevent perforation of the thin-walled diverticulum. [aibolita.com]
One advantage to an antireflux procedure is the prevention of acid reflux following the disruption of the gastroesophageal junction, which may occur if the myotomy is extended onto the gastric cardia. [ctsnet.org]
Usually found in pairs on opposite sides of the bladder, bladder diverticula are often surgically removed to prevent infection, rupture, or even cancer. [en.wikipedia.org]
These preventive measures are very important in elderly patients who tend to take multiple medications particularly at bedtime. Chronic lesions caused by mucosal injury often lead to strictures. [clevelandclinicmeded.com]