Zenker's diverticulum differential diagnosis: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{ | [[Image:Home_logo1.png|right|250px|link=https://www.wikidoc.org/index.php/Zenker%27s_diverticulum]] | ||
{{ | {{CMG}} {{AE}} {{Ajay}} | ||
==Overview== | ==Overview== | ||
The differential diagnosis of the [[Zenker's diverticulum]] (ZD) are as follows [[Plummer-Vinson syndrome]], [[reflux esophagitis]], [[esophageal carcinoma]], [[Systemic sclerosis|systemic sclerosis,]] [[achalasia]], psuedoachalasia, [[chagas disease]], [[esophageal candidiasis]], [[pharyngitis]] and [[stroke]]. | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
{{familytree/start}} | {{familytree/start}} | ||
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Zenker's diverticulum must be differentiated from other diseases that cause dysphagia such as [[reflux esophagitis]], [[esophageal carcinoma]], [[systemic sclerosis]], [[esophageal spasm]], [[pseudoachalasia]], [[stroke]], [[esophageal candidiasis]] and [[Chagas disease]].<ref>{{cite book | last = Ferri | first = Fred | title = Ferri's clinical advisor 2015 : 5 books in 1 | publisher = Elsevier/Mosby | location = Philadelphia, PA | year = 2015 | isbn = 978-0323083751 }}</ref><ref name="pmid23871090">{{cite journal| author=Boeckxstaens GE, Zaninotto G, Richter JE| title=Achalasia. | journal=Lancet | year= 2013 | volume= | issue= | pages= | pmid=23871090 | doi=10.1016/S0140-6736(13)60651-0 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23871090 }}</ref><ref name="pmid25133039">{{cite journal |vauthors=Badillo R, Francis D |title=Diagnosis and treatment of gastroesophageal reflux disease |journal=World J Gastrointest Pharmacol Ther |volume=5 |issue=3 |pages=105–12 |year=2014 |pmid=25133039 |pmc=4133436 |doi=10.4292/wjgpt.v5.i3.105 |url=}}</ref><ref name="pmid24834141">{{cite journal |vauthors=Napier KJ, Scheerer M, Misra S |title=Esophageal cancer: A Review of epidemiology, pathogenesis, staging workup and treatment modalities |journal=World J Gastrointest Oncol |volume=6 |issue=5 |pages=112–20 |year=2014 |pmid=24834141 |pmc=4021327 |doi=10.4251/wjgo.v6.i5.112 |url=}}</ref><ref name="pmid28943381">{{cite journal |vauthors=Matsuura H |title=Diffuse Esophageal Spasm: Corkscrew Esophagus |journal=Am. J. Med. |volume= |issue= |pages= |year=2017 |pmid=28943381 |doi=10.1016/j.amjmed.2017.08.041 |url=}}</ref><ref name="pmid1736462">{{cite journal |vauthors=Lassen JF, Jensen TM |title=[Corkscrew esophagus] |language=Danish |journal=Ugeskr. Laeg. |volume=154 |issue=5 |pages=277–80 |year=1992 |pmid=1736462 |doi= |url=}}</ref><ref name="pmid17227515">{{cite journal |vauthors=Ruigómez A, García Rodríguez LA, Wallander MA, Johansson S, Eklund S |title=Esophageal stricture: incidence, treatment patterns, and recurrence rate |journal=Am. J. Gastroenterol. |volume=101 |issue=12 |pages=2685–92 |year=2006 |pmid=17227515 |doi=10.1111/j.1572-0241.2006.00828.x |url=}}</ref><ref name="pmid25013392">{{cite journal |vauthors=Shami VM |title=Endoscopic management of esophageal strictures |journal=Gastroenterol Hepatol (N Y) |volume=10 |issue=6 |pages=389–91 |year=2014 |pmid=25013392 |pmc=4080876 |doi= |url=}}</ref><ref name="pmid11753173">{{cite journal |vauthors=López Rodríguez MJ, Robledo Andrés P, Amarilla Jiménez A, Roncero Maíllo M, López Lafuente A, Arroyo Carrera I |title=Sideropenic dysphagia in an adolescent |journal=J. Pediatr. Gastroenterol. Nutr. |volume=34 |issue=1 |pages=87–90 |year=2002 |pmid=11753173 |doi= |url=}}</ref><ref name="pmid4449772">{{cite journal |vauthors=Chisholm M |title=The association between webs, iron and post-cricoid carcinoma |journal=Postgrad Med J |volume=50 |issue=582 |pages=215–9 |year=1974 |pmid=4449772 |pmc=2495558 |doi= |url=}}</ref><ref name="pmid1192404">{{cite journal |vauthors=Larsson LG, Sandström A, Westling P |title=Relationship of Plummer-Vinson disease to cancer of the upper alimentary tract in Sweden |journal=Cancer Res. |volume=35 |issue=11 Pt. 2 |pages=3308–16 |year=1975 |pmid=1192404 |doi= |url=}}</ref> | Zenker's diverticulum must be differentiated from other diseases that cause dysphagia such as [[reflux esophagitis]], [[esophageal carcinoma]], [[systemic sclerosis]], [[esophageal spasm]], [[pseudoachalasia]], [[stroke]], [[esophageal candidiasis]] and [[Chagas disease]].<ref>{{cite book | last = Ferri | first = Fred | title = Ferri's clinical advisor 2015 : 5 books in 1 | publisher = Elsevier/Mosby | location = Philadelphia, PA | year = 2015 | isbn = 978-0323083751 }}</ref><ref name="pmid23871090">{{cite journal| author=Boeckxstaens GE, Zaninotto G, Richter JE| title=Achalasia. | journal=Lancet | year= 2013 | volume= | issue= | pages= | pmid=23871090 | doi=10.1016/S0140-6736(13)60651-0 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23871090 }}</ref><ref name="pmid25133039">{{cite journal |vauthors=Badillo R, Francis D |title=Diagnosis and treatment of gastroesophageal reflux disease |journal=World J Gastrointest Pharmacol Ther |volume=5 |issue=3 |pages=105–12 |year=2014 |pmid=25133039 |pmc=4133436 |doi=10.4292/wjgpt.v5.i3.105 |url=}}</ref><ref name="pmid24834141">{{cite journal |vauthors=Napier KJ, Scheerer M, Misra S |title=Esophageal cancer: A Review of epidemiology, pathogenesis, staging workup and treatment modalities |journal=World J Gastrointest Oncol |volume=6 |issue=5 |pages=112–20 |year=2014 |pmid=24834141 |pmc=4021327 |doi=10.4251/wjgo.v6.i5.112 |url=}}</ref><ref name="pmid28943381">{{cite journal |vauthors=Matsuura H |title=Diffuse Esophageal Spasm: Corkscrew Esophagus |journal=Am. J. Med. |volume= |issue= |pages= |year=2017 |pmid=28943381 |doi=10.1016/j.amjmed.2017.08.041 |url=}}</ref><ref name="pmid1736462">{{cite journal |vauthors=Lassen JF, Jensen TM |title=[Corkscrew esophagus] |language=Danish |journal=Ugeskr. Laeg. |volume=154 |issue=5 |pages=277–80 |year=1992 |pmid=1736462 |doi= |url=}}</ref><ref name="pmid17227515">{{cite journal |vauthors=Ruigómez A, García Rodríguez LA, Wallander MA, Johansson S, Eklund S |title=Esophageal stricture: incidence, treatment patterns, and recurrence rate |journal=Am. J. Gastroenterol. |volume=101 |issue=12 |pages=2685–92 |year=2006 |pmid=17227515 |doi=10.1111/j.1572-0241.2006.00828.x |url=}}</ref><ref name="pmid25013392">{{cite journal |vauthors=Shami VM |title=Endoscopic management of esophageal strictures |journal=Gastroenterol Hepatol (N Y) |volume=10 |issue=6 |pages=389–91 |year=2014 |pmid=25013392 |pmc=4080876 |doi= |url=}}</ref><ref name="pmid11753173">{{cite journal |vauthors=López Rodríguez MJ, Robledo Andrés P, Amarilla Jiménez A, Roncero Maíllo M, López Lafuente A, Arroyo Carrera I |title=Sideropenic dysphagia in an adolescent |journal=J. Pediatr. Gastroenterol. Nutr. |volume=34 |issue=1 |pages=87–90 |year=2002 |pmid=11753173 |doi= |url=}}</ref><ref name="pmid4449772">{{cite journal |vauthors=Chisholm M |title=The association between webs, iron and post-cricoid carcinoma |journal=Postgrad Med J |volume=50 |issue=582 |pages=215–9 |year=1974 |pmid=4449772 |pmc=2495558 |doi= |url=}}</ref><ref name="pmid1192404">{{cite journal |vauthors=Larsson LG, Sandström A, Westling P |title=Relationship of Plummer-Vinson disease to cancer of the upper alimentary tract in Sweden |journal=Cancer Res. |volume=35 |issue=11 Pt. 2 |pages=3308–16 |year=1975 |pmid=1192404 |doi= |url=}}</ref> | ||
<small> | |||
<small> | <small> | ||
{| class="wikitable" | {| class="wikitable" | ||
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| align="center" style="background:#4479BA; color: #FFFFFF;" |Type | | align="center" style="background:#4479BA; color: #FFFFFF;" |Type | ||
|- | |- | ||
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |Plummer-Vinson syndrome | | style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Plummer-Vinson syndrome]] | ||
|Gradual | | | ||
* Gradual | |||
| + | | + | ||
| - | | - | ||
Line 68: | Line 70: | ||
|Normal | |Normal | ||
| | | | ||
* Thin projections on the | * Thin projections on the anterior [[esophageal]] wall | ||
* Multiple upper[[Esophageal stricture|esophageal constrictions]] | * Multiple upper [[Esophageal stricture|esophageal constrictions]] | ||
| | | | ||
* Direct visualization of [[esophageal webs]] | * Direct visualization of [[esophageal webs]] | ||
* Superior to [[esophagogram]] | * Superior to [[esophagogram]] | ||
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|- | |- | ||
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Esophageal stricture]] | | style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Esophageal stricture]] | ||
|Gradual | | | ||
* Gradual | |||
* Sudden onset | |||
| + | | + | ||
| - | | - | ||
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* Circumferential thickening in [[Gastroesophageal reflux disease|GERD]] | * Circumferential thickening in [[Gastroesophageal reflux disease|GERD]] | ||
* Pale [[mucosa]] with white [[exudate]] in lymphocytic esophagitis | * Pale [[mucosa]] with white [[exudate]] in lymphocytic esophagitis | ||
* [[Swelling]] and [[hemorrhagic]] [[congestion]] in [[caustic]]<nowiki/> ingestion | |||
* [[Swelling]] and [[hemorrhagic]] [[congestion]] in [[caustic]]<nowiki/>ingestion | |||
| | | | ||
* [[Manometry]] may show dysmotility | * [[Manometry]] may show dysmotility | ||
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|- | |- | ||
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Diffuse esophageal spasm]] | | style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Diffuse esophageal spasm]] | ||
|Sudden | | | ||
* Sudden | |||
|<nowiki>+</nowiki> | |<nowiki>+</nowiki> | ||
|<nowiki>+</nowiki> | |<nowiki>+</nowiki> | ||
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|- | |- | ||
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Achalasia]] | | style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Achalasia]] | ||
|Gradual | | | ||
* Gradual | |||
| + | | + | ||
|<nowiki>+</nowiki> | |<nowiki>+</nowiki> | ||
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|- | |- | ||
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Systemic sclerosis]] | | style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Systemic sclerosis]] | ||
|Gradual | | | ||
* Gradual | |||
| + | | + | ||
|<nowiki>+</nowiki> | |<nowiki>+</nowiki> | ||
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|- | |- | ||
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Zenker's diverticulum]] | | style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Zenker's diverticulum]] | ||
|Gradual | | | ||
* Gradual | |||
| + | | + | ||
|<nowiki>-</nowiki> | |<nowiki>-</nowiki> | ||
Line 215: | Line 223: | ||
* Outpouching of posterior [[pharyngeal]] wall | * Outpouching of posterior [[pharyngeal]] wall | ||
* Exclude the presence of [[Squamous cell carcinoma|SCC]] | * Exclude the presence of [[Squamous cell carcinoma|SCC]] | ||
| | | | ||
* [[CT]] & [[MRI]] shows out-pouching over the posterior esophagus in the Killian's triangle | * [[CT]] & [[MRI]] shows out-pouching over the posterior esophagus in the Killian's triangle | ||
Line 222: | Line 230: | ||
|- | |- | ||
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Esophageal carcinoma]] | | style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Esophageal carcinoma]] | ||
|Gradual | | | ||
* Gradual | |||
|<nowiki>+</nowiki> | |<nowiki>+</nowiki> | ||
|<nowiki>+</nowiki> | |<nowiki>+</nowiki> | ||
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| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Stroke]] | | style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Stroke]] | ||
([[Cerebral hemorrhage]]) | ([[Cerebral hemorrhage]]) | ||
|Sudden | | | ||
* Sudden | |||
|<nowiki>+</nowiki> | |<nowiki>+</nowiki> | ||
|<nowiki>+</nowiki> | |<nowiki>+</nowiki> | ||
Line 272: | Line 282: | ||
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |Motor disorders | | style="padding: 5px 5px; background: #DCDCDC;" align="center" |Motor disorders | ||
([[Myasthenia gravis]]) | ([[Myasthenia gravis]]) | ||
|Gradual | | | ||
* Gradual | |||
| + | | + | ||
| + | | + | ||
Line 295: | Line 306: | ||
|- | |- | ||
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[GERD]] | | style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[GERD]] | ||
|Gradual | | | ||
* Gradual | |||
* Sudden onset | |||
| + | | + | ||
| - | | - | ||
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|- | |- | ||
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Esophageal web]] | | style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Esophageal web]] | ||
|Gradual | | | ||
* Gradual | |||
| + | | + | ||
| +/- | | +/- | ||
Line 340: | Line 353: | ||
* Barium [[esophagogram]] | * Barium [[esophagogram]] | ||
|} | |} | ||
</small></small> | |||
==References== | ==References== | ||
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[[Category:Needs patient information]] | [[Category:Needs patient information]] | ||
[[Category:Disease]] | [[Category:Disease]] | ||
[[Category:Differential diagnosis]] | |||
{{WS}} | {{WS}} | ||
{{WH}} | {{WH}} |
Latest revision as of 22:04, 7 February 2019
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Ajay Gade MD[2]]
Overview
The differential diagnosis of the Zenker's diverticulum (ZD) are as follows Plummer-Vinson syndrome, reflux esophagitis, esophageal carcinoma, systemic sclerosis, achalasia, psuedoachalasia, chagas disease, esophageal candidiasis, pharyngitis and stroke.
Differential Diagnosis
Dysphagia | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Oropharyngeal dysphagia | Esophageal dysphagia | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Solids only | Solids and Liquids | Solids only | Solids and Liquids | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
•Zenker's diverticulum •Neoplasm •Webs | Neurogenic | Myogenic | Pain | •Achalasia •Scleroderma •DES | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
•Myasthenia gravis •Connective tissue disorder •Myotonic dystrophy | No | Yes | Heart burn | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Barium swallow | Mental status | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
•Pill esophagitis •Caustic injury •Chemotherapy | Yes | No | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Impaired | Normal | Non progressive | Progressive | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Sac | Webs | Mass | Scleroderma | •Achalasia •DES | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Stroke | •ALS •Parkinsonism | •Rings •Webs | •Strictures •Cancer | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Zenker's diverticulum | Plummer-Vinson syndrome | Carcinoma | Chest pain and manometry | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Barium swallow | Weight loss | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Increase LES pressure | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Rings | Webs | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Yes | No | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Rapid | Slow | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Achalasia | DES | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Cancer | Strictures/GERD | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Zenker's diverticulum must be differentiated from other diseases that cause dysphagia such as reflux esophagitis, esophageal carcinoma, systemic sclerosis, esophageal spasm, pseudoachalasia, stroke, esophageal candidiasis and Chagas disease.[1][2][3][4][5][6][7][8][9][10][11]
Disease | Signs and Symptoms | Barium esophagogram | Endoscopy | Other imaging and laboratory findings | Gold Standard | |||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Onset | Dysphagia | Weight loss | Heartburn | Other findings | Mental status | |||||||
Solids | Liquids | Type | ||||||||||
Plummer-Vinson syndrome |
|
+ | - | Non progressive | +/- | - | Normal |
|
|
|
Triad of | |
Esophageal stricture |
|
+ | - | Progressive | +/- | +/- | Normal |
|
|
|
||
Diffuse esophageal spasm |
|
+ | + | Non progressive | + | + | Normal |
|
|
|
||
Achalasia |
|
+ | + | Non progressive | +/- | - |
|
Normal |
|
|||
Systemic sclerosis |
|
+ | + | Progressive | +/- | + |
|
Normal |
|
|
Positive serology for | |
Zenker's diverticulum |
|
+ | - | +/- | - |
|
Normal |
|
|
| ||
Esophageal carcinoma |
|
+ | + | Progressive | + | +/- | Normal |
|
|
|||
Stroke |
|
+ | + | Progressive | + | +/- |
|
Impaired |
|
|
||
Motor disorders |
|
+ | + | Progressive | +/- | Normal |
|
|
|
| ||
GERD |
|
+ | - | Progressive | +/- | + | Normal |
|
|
| ||
Esophageal web |
|
+ | +/- | Progressive | - | +/- |
|
Normal |
|
|
|
|
References
- ↑ Ferri, Fred (2015). Ferri's clinical advisor 2015 : 5 books in 1. Philadelphia, PA: Elsevier/Mosby. ISBN 978-0323083751.
- ↑ Boeckxstaens GE, Zaninotto G, Richter JE (2013). "Achalasia". Lancet. doi:10.1016/S0140-6736(13)60651-0. PMID 23871090.
- ↑ Badillo R, Francis D (2014). "Diagnosis and treatment of gastroesophageal reflux disease". World J Gastrointest Pharmacol Ther. 5 (3): 105–12. doi:10.4292/wjgpt.v5.i3.105. PMC 4133436. PMID 25133039.
- ↑ Napier KJ, Scheerer M, Misra S (2014). "Esophageal cancer: A Review of epidemiology, pathogenesis, staging workup and treatment modalities". World J Gastrointest Oncol. 6 (5): 112–20. doi:10.4251/wjgo.v6.i5.112. PMC 4021327. PMID 24834141.
- ↑ Matsuura H (2017). "Diffuse Esophageal Spasm: Corkscrew Esophagus". Am. J. Med. doi:10.1016/j.amjmed.2017.08.041. PMID 28943381.
- ↑ Lassen JF, Jensen TM (1992). "[Corkscrew esophagus]". Ugeskr. Laeg. (in Danish). 154 (5): 277–80. PMID 1736462.
- ↑ Ruigómez A, García Rodríguez LA, Wallander MA, Johansson S, Eklund S (2006). "Esophageal stricture: incidence, treatment patterns, and recurrence rate". Am. J. Gastroenterol. 101 (12): 2685–92. doi:10.1111/j.1572-0241.2006.00828.x. PMID 17227515.
- ↑ Shami VM (2014). "Endoscopic management of esophageal strictures". Gastroenterol Hepatol (N Y). 10 (6): 389–91. PMC 4080876. PMID 25013392.
- ↑ López Rodríguez MJ, Robledo Andrés P, Amarilla Jiménez A, Roncero Maíllo M, López Lafuente A, Arroyo Carrera I (2002). "Sideropenic dysphagia in an adolescent". J. Pediatr. Gastroenterol. Nutr. 34 (1): 87–90. PMID 11753173.
- ↑ Chisholm M (1974). "The association between webs, iron and post-cricoid carcinoma". Postgrad Med J. 50 (582): 215–9. PMC 2495558. PMID 4449772.
- ↑ Larsson LG, Sandström A, Westling P (1975). "Relationship of Plummer-Vinson disease to cancer of the upper alimentary tract in Sweden". Cancer Res. 35 (11 Pt. 2): 3308–16. PMID 1192404.