Esophageal intramural pseudodiverticulosis is an uncommon condition comprising of numerous small outpouchings within the esophageal wall.
Occurs in all age groups, but more commonly in the 6th and 7th decades. There is a slight male predominance 2.
- esophageal strictures: present in 90% of patients1
- esophageal candidiasis
- esophageal carcinoma2
Intramural pseudodiverticula represent dilated excretory ducts of the deep esophageal mucosal glands1.
Fluoroscopy: Barium swallow
Barium swallow examination is the study of choice, as the ductal orifices are too small to be seen on endoscopy. Pseudodiverticula are best seen with a single contrast, rather than a double contrast, thin barium examination1,2.
The findings are:
- numerous tiny 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 impercebtible. Viewed on face, may look like ulcers 3
- intramural tracking may sometimes be seen bridging two or more pseudodiverticula 4 .
Pseudodiverticular rupture with mediastinitis has been reported but is very rare 4.