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 between ages 50 and 70. There is a slight male predominance 2.
- esophageal strictures: present in 90% of patients 1
- gastroesophageal reflux
- esophageal candidiasis
- chronic esophagitis
- esophageal carcinoma 2
Intramural pseudodiverticula represent dilated excretory ducts of the deep esophageal mucosal glands 1.
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 appear as ulcers 3
- intramural tracking may sometimes be seen bridging two or more pseudodiverticula 2
Treatment and prognosis
Pseudodiverticular rupture with resultant mediastinitis has been reported but is very rare 4.