Zenker diverticulum

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Summary of Zenker diverticulum

A Zenker's diverticulum is a diverticulum of the mucosa of the pharynx, just above the cricopharyngeal muscle (i.e. above the upper sphincter of the esophagus). It is a false diverticulum (not involving all layers of the esophageal wall). Presenting symptoms include dysphagia, obstruction, gurgling, aspiration, foul breath, and possibly a neck mass.

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Zenker diverticulum

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Zenker diverticulum

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USMLE® Step 1 style questions USMLE

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A 68-year-old man comes to the emergency department because of worsening shortness of breath, pleuritic chest pain, and cough. Symptoms have been consistent for the past nine days. The patient also says that, for about a year, he has been regurgitating food during meals, has had trouble swallowing solids, and has been receiving complaints of bad breath. He denies any dysphagia to liquids and denies having gastroesophageal reflux disease. His temperature is 38.8°C (101.8°F), pulse is 85/min, respirations are 28/min, and blood pressure is 125/75 mm Hg. Chest X-ray shows consolidation in the right lower lung and the patient is treated for pneumonia. After recovering from his infection, he comes to the outpatient clinic for a follow-up evaluation. A barium swallow test is ordered and the results of which are shown below. Which of the following is the most likely diagnosis?