Killian-Jamieson Diverticula Presenting Synchronously with Thyroid Adenoma
A 74-year-old woman who had suffered from mild dysphagia during 2 months was admitted to our hospital because of exacerbation of the symptom and awareness of a tumor in the left side of the neck 1 month before. Laboratory data revealed normal thyroid function. Pharyngoesophagography showed a large diverticulum retaining a meal rest at the pharyngoesophageal junction (fig. ). Ultrasonography showed a hypoechoic lesion containing echogenic foci that were suggestive of a meal rest in the posterior bilateral lobe of the thyroid (fig. ), and showed an isoechoic mass measuring 30.6 × 16.7 mm in the left lobe of the thyroid (fig. ). Cervical computed tomography (CT) showed a thyroid nodule and bilateral hypopharyngeal diverticula (fig. ). The hypopharyngeal diverticula arose bilaterally from the cervical esophagus and were located just below the cricoid cartilage (fig. ). There was heterogeneous material on both hypopharyngeal diverticula. The thyroid nodule was noted to contain an isodensity area with a hyperdensity area that was suggestive of calcium deposition (fig. ). A barium swallow pharyngoesophagogram showed a large left-sided diverticulum 4 cm in diameter and a small right-sided diverticulum 1.5 cm in diameter of the pharyngoesophageal junction in the frontal position (fig. ), and showed the left-sided diverticulum overlapping the anterior wall of the cervical esophagus in the lateral position (fig. ). These imaging findings indicated the co-existence of Killian-Jamieson diverticula and a thyroid tumor.\nThe patient underwent resection of the diverticula and the thyroid tumor for improvement of dysphagia. The surgical operation was approached through a collar incision in the left anterior neck. The subcutaneous tissue and platysma were divided. After dividing the omohyoid muscle and the cervical esophagus, the bilateral diverticula were visualized under the cricopharyngeus muscle. The left-sided diverticulum above the upper esophageal longitudinal muscle was mobilized from the left lobe of the thyroid and the thyroid tumor (fig. ), taking care not to injure the recurrent laryngeal nerve, which runs in the tracheoesophageal groove. The thyroid tumor was resected from the normal thyroid gland, then a diverticulotomy was performed. With a fiberscope in the esophagus for bougie to prevent esophageal stenosis after diverticulotomy, each diverticulum was transected at its base using a linear stapling device (Endo-GIA 30-3.5®). The wound was closed in layers with placement of a closed suction drain. Histopathological examination showed a thyroid tumor and both diverticula were diagnosed as thyroid adenoma and false diverticula without a muscular layer. The patient was started on a clear liquid diet on postoperative day 4. Two years after surgery, the patient remains free of dysphagia.