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A Case of Dysphagia and Aspiration Pneumonia

Maryse Brassard, MD, Don Echenberg, MD, Pierre Charron, MD

About the Authors

Maryse Brassard, Don Echenberg, and Pierre Charron are affiliated with the University of Sherbrooke, Quebec.

An 84-year-old man with a 15-year history of progressive dysphagia first to liquids and then solids associated with almost a 7 kg (15 lb) weight loss over the previous 6 months was admitted to the internal medical service with aspiration pneumonia. A barium swallow showed a 7.5 × 6.5 cm Zenker’s diverticulum in the right posteromedial plane with a mass effect on the adjacent proximal esophagus. The barium made its way preferentially into the diverticulum and then overflowed into the pharynx and trachea (Figure 1).

Figure 1. Barium flowed into Zenker’s diverticulum and then overflowed into the pharynx and trachea (red arrow).

At surgery, the large Zenker’s diverticulum was successfully removed (Figure 2).

Figure 2. Zenker’s diverticulum was successfully removed.

Zenker’s diverticulum is an esophageal mucosa outpouching forming in a vulnerable muscular anatomical zone called Killian’s triangle, between the transverse fibres of the cricopharyngeus and the oblique fibres of the lower inferior constrictor. A surgical approach with cricopharyngeal myotomy is the most widely used method for excision.

Article citation: Brassard M, Echenberg D, Charron P. A Case of Dyshpagia and Aspiration Pneumonia. Can J Intern Med 2008;3(2):62