Answer of May 2021

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Clinical History:

A 70 years old female patient presents with neck discomfort

Axial image of contrast CT neck

Selected images of barium swallow (frontal and lateral views)

IMAGING FINDINGS:

Axial image of contrast CT neck shows a lesion on the left side of the upper oesophagus with internal mottled gas densities. 

DIAGNOSIS:

Killian-Jamieson diverticulum

DISCUSSION:

Killian-Jamieson diverticulum is an uncommon diverticulum which arises from the upper oesophageal region. Anatomically, it is a protrusion through a congenital weakness point named Killian-Jamieson space (not to be confused with Killian’s dehiscence). This space is bounded superiorly by the cricopharyngeus muscle, anteriorly by the posterior wall of the cricoid cartilage, and inferomedially by the longitudinal tendon of the oesophagus as it inserts onto the cricoid cartilage. It is where the recurrent laryngeal nerve enters the pharynx

Zenker’s diverticulum is another type of diverticulum that also arises from the upper oesophageal region. It originates at the posterior wall of the pharyngoesophageal segment in a midline area of weakness just above the cricopharyngeus (Killian's dehiscence).

Killian-Jamieson diverticula are four times less frequent than Zenker’s diverticula. They tend to be smaller than Zenker’s diverticula. They occur more frequently on the left side but can be bilateral. Killian-Jamieson diverticula are less likely to cause symptoms and are less likely to be associated with overflow aspiration or gastroesophageal reflux than Zenker's diverticula.