Revision 13 for 'Esophageal pseudodiverticulosis'

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Esophageal pseudodiverticulosis

Esophageal intramural pseudodiverticulosis is an uncommon condition in which there are numerous small outpouchings within the esophageal wall.


It is a rare condition, found in <1% of oesophagrams. It may occur at any age, but is more common at 50-70 years old. There is a slight male predominance 2.



Intramural pseudodiverticula represent dilated excretory ducts of the deep esophageal mucosal glands 1.

Radiographic features

Fluoroscopy: barium swallow

Barium swallow examination is the study of choice, as the ductal orifices may be too small to be seen on endoscopy. Pseudodiverticula are better seen with a single contrast examination than with a double contrast, thin barium examination 1,2

  • numerous, tiny (1-4 mm), flask-shaped outpouchings
  • may be diffusely distributed or clustered.
  • clustering may occur next to peptic strictures
  • viewed in profile, often appear “floating” next to the esophageal wall, as the channel to the lumen is imperceptible
  • viewed en face, may look like ulcers 3
  • intramural tracking may sometimes be seen bridging two or more pseudodiverticula 2 

Treatment and prognosis

Pseudodiverticular rupture with mediastinitis has been reported but is very rare 4.

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