Learning Radiology xray montage

Esophageal Intramural Pseudodiverticulosis

General Considerations

  • Rare
  • Multiple flask-shaped outpouchings in the esophageal wall
  • Believed to be a reaction to chronic irritation, such as from
    • Reflux
    • Alcoholism
    • Diabetes mellitus
    • Candidiasis
  • EIP shows two peak incidences, one in the teens and the other in the 50s and 60s

Clinical Findings

  • About 75% have dysphagia
  • But it can be found incidentally

Imaging Findings

  • Flask-shaped outpouchings into esophageal wall from about 1-4 mm in length and 1-2 mm in width
  • They are distributed diffusely in 60% of patients and focally in 40% (upper 14%, middle 14%, and lower 12%)
  • Patients often have esophageal strictures, as well, particularly of the upper esophagus
  • Intramural tracking is often seen

Differential Diagnosis

  • Esophagitis
  • Carcinoma of the esophagus


  • Proton-pump inhibitors
  • Dilatation of strictures


  • Increased risk of esophageal carcinoma, but no cause and effect shown

Intramural Pseudodiverticula

Intramural Pseudodiverticulosis. Two images from a barium esophagram show innumerable, small outpouchings of barium extending from the lumen into the wall. (white ovals) There are also linear collections indicating intramural tracking.
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Esophageal intramural pseudodiverticulosis: a reevaluation  MS Levine, DN  Moolten, H Herlinger and I Laufer.. Am J Roentgenol 1986;147:1165-70

A Case of Esophageal Intramural Pseudodiverticulosis. YE Chon, S Hwang, KS Jung, HJ Lee, SG Lee, SK Shin, and YC Lee. Gut Liver. 2011 March; 5(1): 93–95.