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Killian-Jamieson Diverticula

Radiographic Findings in 16 Patients

Stephen E. Rubesin1 and Marc S. Levine

1 Both authors: Department of Radiology, Hospital of the University of Pennsylvania, MRI Bldg. 1, 3400 Spruce St., Philadelphia, PA 19104-4283.



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  		Fig. 1A. —79-year-old man with suprasternal dysphagia. During videofluoroscopy (not shown), pharyngeal motility was abnormal, with diminished elevation of pharynx and diminished epiglottic tilt, resulting in laryngeal penetration. Patient repeatedly double-swallowed. Spot radiograph obtained with patient in frontal position shows 2-cm left-sided Killian-Jamieson diverticulum (large white arrow) with wide neck (double white arrow). Diverticulum is filled with debris, manifested as tiny radiolucent filling defects in barium pool. Right-sided Killian-Jamieson diverticulum of 4 mm in diameter is barely visible, obscured by barium bolus. Note second swallow manifested as barium column surrounding tilting epiglottis (e). Also note right and left lateral pharyngeal pouches (small white arrows).

 


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  		Fig. 1B. —79-year-old man with suprasternal dysphagia. During videofluoroscopy (not shown), pharyngeal motility was abnormal, with diminished elevation of pharynx and diminished epiglottic tilt, resulting in laryngeal penetration. Patient repeatedly double-swallowed. Spot radiograph obtained after bolus passage shows 2-cm left (large white arrow) and 0.4-cm right (small white arrow) Killian-Jamieson diverticula. Neck of left-sided diverticulum (double black arrow) has narrowed in comparison with that in A. Note residual debris in larger diverticulum and barium-coated left true vocal cord (t).

 


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  		Fig. 1C. —79-year-old man with suprasternal dysphagia. During videofluoroscopy (not shown), pharyngeal motility was abnormal, with diminished elevation of pharynx and diminished epiglottic tilt, resulting in laryngeal penetration. Patient repeatedly double-swallowed. Spot radiograph obtained with patient in lateral position shows left (large white arrow) and right (small white arrow) diverticula overlapping collapsed barium-coated cervical esophagus (black arrow).

 


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  		Fig. 1D. —79-year-old man with suprasternal dysphagia. During videofluoroscopy (not shown), pharyngeal motility was abnormal, with diminished elevation of pharynx and diminished epiglottic tilt, resulting in laryngeal penetration. Patient repeatedly double-swallowed. Spot radiograph obtained during bolus passage with patient in lateral position shows larger left-sided diverticulum (large white arrow) inferior to prominent cricopharyngeus (large black arrow). Diverticulum overlaps anterior wall of cervical esophagus (small black arrow).

 


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  		Fig. 2. —50-year-old man with epigastric pain. Spot radiograph of pharyngoesophageal junction area obtained with patient in frontal position shows 2 x 1 cm left-sided Killian-Jamieson diverticulum (large arrow). Note broad opening (small arrow) of diverticulum during passage of barium bolus.

 


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  		Fig. 3A. —90-year-old man with history of aspiration pneumonia. Spot radiograph of pharyngoesophageal junction region obtained with patient in right posterior oblique position shows Zenker's diverticulum (large arrow) protruding posterior to pharyngoesophageal segment (long thin arrow). Killian-Jamieson diverticulum (medium arrow) overlaps proximal cervical esophagus.

 


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  		Fig. 3B. —90-year-old man with history of aspiration pneumonia. Spot radiograph obtained with patient in frontal position shows 3-cm Zenker's diverticulum (Z) and 1.5-cm left-sided Killian-Jamieson diverticulum (K). Barium reflux from Zenker's diverticulum into lower hypopharynx (arrow) is seen.

 

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