The cause is not known, but the initiating event is suspected to be chronic inflammation of the submucosal esophageal glands by infectious (e.g., candida, bacteria) or chemical (e.g., gastroesophageal reflux) insult. Obstruction of the ductal orifices due to inflammation and/or fibrosis then leads to dilatation of the ducts.
The diverticula may be distributed in a segmental or diffuse manner. The diffuse form is associated with strictures in the upper or mid esophagus, while the localized form tends to be associated with peptic strictures in the distal esophagus.
On barium swallow, there are multiple flask- or collar button-shaped outpouchings at right angles to the lumen. These outpouchings measure between 1 mm - 4 mm and communicate with the lumen through narrow openings. Intramural tracks can bridge two or more adjoining pseudodiverticula and may mimic a large ulcer when viewed obliquely.
On CT, there is esophageal wall thickening, irregularity of the lumen, and intramural gas.
References
- Sabanathan S, Salama FD, Morgan WE Oesophageal intramural pseudodiverticulosis. Thorax 1985;40:849-857.
- Canon CL, Levine MS, Cherukuri R, Johnson LF, Smith JK, Koehler RE. Intramural tracking: a feature of esophageal intramural pseudodiverticulosis. AJR Am J Roentgenol. 2000;175;371-4.
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