What's the most likely diagnosis?

• 63 year-old with dysphagia

1. Zenker diverticulum
2. Carcinoma of the esophagus
3. Prominent cricopharyngeus
4. External compression by osteophytes
5. Esophageal web

Answer:

 

3. Prominent cricopharyngeus

 

 

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Prominent Cricopharyngeus

• Lies at the junction of the hypopharynx and cervical esophagus, posteriorly at about the level of C5-C6
• The cricopharyngeus muscle is part of the upper esophageal sphincter mechanism
• The cricopharyngeus muscle is normally contracted at rest
• Upon the initiation of swallowing, the normal cricopharyngeus muscle relaxes in anticipation of the bolus and helps to form part of the pharyngeal peristaltic wave
• Therefore, the cricopharyngeus muscle is usually not seen on a barium swallow
• A prominent cricopharyngeus, however, can be seen on barium swallows in about 5-10% of asymptomatic individuals

 

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