[aktorque]

A 74-year-old Caucasian female presents to the physician's office for evaluation of choking spells, dysphagia, and coughing. She suffers from recurrent pneumonia and has a long hi stow of hypertension, but no other medical problems. Barium swallow is shown below. Which of the following is the most likely cause of her symptoms?

A. Degenerative changes of the myenteric plexus
B. Cricopharyngeal motor dysfunction
C. Scarring and traction of the esophagus
D. Retention cyst due to duct obstruction
E. Increased intraluminal pressure in the stomach

 

[donofitaly]

A. Degenerative changes of the myenteric plexus

 

[patelMD]

D) Retention cyst?

I swear at first site that looks like a fistula formation.

 

[Chow]

B. Cricopharyngeal motor dysfunction

 

[struggle]

its B

cricopharyngeal motor dysfunction.

 

[prion.pk]

B

answer is B

 

[sona]

b

it's B .......

 

[patelMD]

Yep, just google imaged it.. it is infact B

Can someone explain the pathology? :notsure:

 

[namita]

i think its zenker's diverticulum, formed between transverse and oblique fibres of cricopharyngeus muscle.

 

[Mondoshawan]

Zenker's diverticulum

click image to enlarge

Zenker's traction diverticulum (p.322 RR Pathology 3rd Ed., p.321 FA 2010) may result from uncoordinated muscle contracture in swallowing. Robbins doesn't give an etiology, but Goljan lists weakness of the cricopharyngeus m.

 

[rsin21]

b

inferior constrictor muscle of pharynx has two parts
1: oblique thyropharyngeal
2: circular cricopharyngeal
potential weak triangular space is formed between them(killans)
normally when oblique muscle contract circular muscle relaxes causing passage of bolus
when circular muscle is in spasm,contraction of oblique muscle causes formation of pharyngeal pouch responsible for above mentioned features...

 

[doctorsmonsters]

Yep, just google imaged it.. it is infact B

Can someone explain the pathology? :notsure:

I think because of the motor dysfunction, the food isn't pushed into the esophagus effectively, which leads to buildup of pressure and causes the diverticulum.

 

[aktorque]

B) Cricopharyngeal motor dysfunction

The ans is B) Cricopharyngeal motor dysfunction.

Cricopharyngeal muscle dysfunction occurs due to diminished relaxation of pharyngeal muscles during swallowing. More force is subsequently required to move the food bolus downward. More intense contractions of the pharyngeal muscles increase the oropharyngeal intraluminal pressure. With time, the pharyngeal mucosa will herniate through muscle fibers in the zone of weakness (posterior hypopharynx), forming a Zenker diverticulum. Remember that when a diverticulum consists only of mucosa, itis a false or pulsion, diverticulum. A traction diverticulum, alternatively, consists of all layers of the organ wall.

Cricopharyngeal dysfunction causes symptoms of "high dysphagia:" difficulty in swallowing felt "at the throat" coughing choking and sometimes even nasal regurgitation. When a Zenker diverticulum forms it can cause food retention with regurgitation occurring days later. Food aspiration may lead to pneumonia, as happened in this patient. The diverticulum can be palpated as a lateral neck mass.