Incidental pharyngoesophageal diverticulum mistaken for a thyroid nodule: Report of two cases

Abstract

Pharyngeal or Zenker's diverticulum is an infrequent disorder that results from an outpouching of pharyngeal mucosa through a weakened area in the posterior pharyngeal wall. As it may mimic a thyroid nodule on ultrasonography (US), accurate diagnosis is important to ensure appropriate treatment. Fine‐needle aspiration (FNA) is recommended for the initial evaluation of thyroid nodules. We report the FNA diagnosis of two cases of Zenker's diverticulum that were suspected to be thyroid nodules on US. Pap stained aspirate smears showed findings characteristic of Zenker's diverticulum: benign squamous cells, bacteria, and vegetable debris and the absence of colloid and/or thyroid epithelial cells. US and CT findings were consistent with the diagnosis.

Pharyngoesophageal diverticulum mimicking thyroid nodules: Some interesting ultrasonographic signs

“…Currently, there are few reports on the sonographic findings of PEDs. In previous reports ( 7 , 14 – 16 ), many researchers have misdiagnosed PED as thyroid nodules and performed FNA or surgical treatment.…”

“…However, while PED is a benign disease of the esophagus, esophago-fiberscopes and transesophageal echocardiography probes may mistakenly enter the diverticulum cavity, especially during ultrasound-guided FNA, which can penetrate the thin diverticulum wall, leading to subsequent inflammation, infection, and other clinical symptoms ( 7 ). Therefore, it is important to differentiate between PED and thyroid nodules.…”

Close encounter of the right‐sided Zenker's diverticulum masquerading as a thyroid nodule

“…Misinterpretation, however, can result in unnecessary risks to the patient beyond bleeding, infection and misdiagnosis. As the cervical oesophagus is left‐sided, left‐sided cervical pharyngeal diverticula are most common (90% of cases) and have previously been reported as being mistaken for a thyroid nodule 6. However, a pharyngeal diverticulum may occur at any anatomical weak point of the posterior oesophageal mucosal wall following increased pressure from uncoordinated muscular contractions.…”

“…As the cervical oesophagus is left-sided, left-sided cervical pharyngeal diverticula are most common (90% of cases) and have previously been reported as being mistaken for a thyroid nodule. [3][4][5][6] However, a pharyngeal diverticulum may occur at any anatomical weak point of the posterior oesophageal mucosal wall following increased pressure from uncoordinated muscular contractions. Rightsided pharyngeal pathology may be more obscure.…”

A Killian‐Jamieson diverticulum potentially mimicking a thyroid nodule: A case report highlighting the cytology of a pharyngoesophageal diverticulum

“…The anatomical proximity of the anterolateral cervical oesophagus and Killian‐Jamieson space to the thyroid gland causes pharyngoesophageal diverticula to mimic thyroid nodules clinically and radiologically. Details of oesophageal content on fine needle aspiration biopsy (FNAB) of the thyroid to discern PED from thyroid nodules have been described in reports 1–7 . Although radiological imaging is needed to differentiate diverticula from thyroid nodules, FNAB has been shown to be a useful initial test to evaluate and diagnose pretenders of thyroidal lesions.…”