Naweed Ashraf

Z,e:n ~et's dliv,ed~ rll.~u'm {!lOs~'e:~~n,rhIYp arll ~IgeH.1dliv'ed~ rll.~u'ml) is an .aJ.cqulr,edi :mllJoJisIJJIhen'll ialtion th WlI,lI'g:h o poil ~ an aM~Ii3, .of EllllIatom![: we:c:ukness illi Ull,e f'BQ:iol1l of the; nico'pharllllig:eus ~ml]sc:i,e· {Kill~~a.rU'·s 'ehisoenloe}_ This d area of a.naiom it we:aJ.klli'ess has :1] eEm va fiaJb~ diesniib ed as :IJ etlllVe,en t he:t illY m:l],~a uy ng:e:uJs and niclJ!phaJryng:elJIS ,mlusclles; or be·twe;efll the: ob;~~qiul,e: alldl horiz:onlttlJ~ Hbe:rs of the: ni'!Jo!p,h1aryng:eus_ PaJti'e:IliEs wiithi Z'e:nlker's d.ived i,culllulm oJ:rnp IIa.ili of COlUigru~ I ~;glmth oki Ilgl a1il:,e:fswa.1111 ngl, Ioo di re'g lUlf'Q IJ .I1, or ow~ iltaft~ l1al~b)lSis_Many iJHti,ents a Z,en~ets diiv,eriiclIl!ulm ~a.v,ean .8i:ssOriElliedi hiatal he:m~a. alld~or ,gi8lstr'!I):esoph,ag:eHII· r,efl ~)L Rar,e:~ ,thl,esJe: dlived icui[aaweoJi~p'llrcaJ~edl t~:y u~ce:r.clltion hstlUma. formlaft i'oIl,Of mifdigillianey_

w~n~

I

K~Imi an~Jami,esorl (~liv,erhElI.JIlla.are a.!:sot'e:rmedl prox imt1i~ ~a~era~ oelV'.~ca.i 'e5iOi~rntli'g:e1aJI (~Iuv,ert~ Il.JI C ~aJor~H~~ra~lhi'H:n:.i d cu~a fW11lUth,e ~,hl.myng,.oeso:p,hjafg:ealJLllnd~Ofl area. lru,ese:'vmiab,~e-siz:edl OUl~~ouchilfl;glS';prolruG:eimmth,e ~ate:ra~WH.IIIoi' m,e: iD,ro;:<iimaloeN~cail ,esojjhaglUls and :ma,YiJe:OOrllfUls:ed w~th Z,efll~e:r"s [~:iIV'Brt~cUl~a_ case .213" ~t as slllowrI th8ll'i: 11111 w Zenker's (~i~verft~'[IJI~a ;pmtm(~Ce thmug!h the: pOis$er~or walmon the:pharyrlg:oe'Siop'hag:ea~ sBgme:lllt .~na midilline: area oi we:aknessjll.Jls~atmill,e' {or within} th,e: oicophEuyng:e:a1 musde:_ Illn [or'liimst, Kili~ia.nl-Jami,eISiolli dli\liedicuia.PJohude: thmuQlrJlth,e a.lll~eroi8li.~eU'l11 wa.lmof! th,eD{OX~mall oerv~cal'esoDhaQlus in a.musclJlllar '~raD'just beJow tbe nicqp,haryng'e:211 musd,e:, .Iat:e:[al to. [Pi,e~.ongiitlU1d1illal ieflidon ·oi th,e ,es:oD'ha~g!Uls be:low its inSiert~onon the ]US~ jJ~]lst,eri6r ~,am~na oi thenicoild JC2lrl:~l!ag:e_The 'Q[2lI:jj,llhatZe·rlJkefs dlive:rticu~um ~)[ot[llJdes I:hro.ru;glhiis klll'own as Kilillia Ili':s (~:ehiis,oeflce; Ull'e ,glBipUlltlI.t a Ki 1m ~allhJam il,eso.n di\lie:rl ~ [LII~UI D'mtmdes UIIrDLI'Qilllis kn,ow n as the ml Ki ~11~8lfIll-Jami,eson space, .

L-ateral pharyngeal pouches arise from an unsupported "weak area' of the thyrohyoid membrane which does not contain a muscular covering" Pouches may be best shown

during the' pharyngeal phase of swallowing or by asking a patient 1:0 blow through closed lips (modified Valsalva
maneuver), These pouches are COmlTIOn in asymptomatic patients and can reach a large size in glassblowers, wind

instrument players, and the elderly ..

Mid-esophageal traction diverticulum

Epiphrenic pulsion diverticulu m

._
Intram ural csophageal pscudodiverriculosis

syndrome, Contrast (arrow) is just proximal to a hlatal hernia,

IFiglure 11.,5. Boerhaave's

extravasation

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