Epiphrenic diverticula Surbhi Gupta, MS4 Radiology 6/2/17

Background DAS, 57 year old female History of COPD, DMII, coronary artery disease, now presenting with shortness of breath, fever, and cough

Initial ddx AND WORKUP Differential diagnosis Workup Pneumonia Viral illness Pulmonary embolism COPD exacerbation Workup Vitals: tachycardia, tachypnea Physical exam: LLE>RLE Labs: expected changes from ESRD, viral respiratory panel positive Chest XR Doppler: negative

readmission Patient discharged on day 2 Readmitted 5 days later with SOB and chest discomfort Workup Vitals: SpO2 87% Physical exam: wnl Labs: expected changes from ESRD Chest XR: unchanged Chest CT

Epiphrenic diverticula overview Herniation of submucosa and mucosa through the muscularis propria Therefore, a false diverticulum Due to increase intraluminal pressure Secondary to Motility disorders: Achalasia, Esophageal spasm Distal esophageal strictures Hiatal hernia Complications Dysphagia Distal esophageal compression Management If symptomatic, target underlying disorder Myomectomy or diverticulectomy

Final diagnosis Asymptomatic epiphrenic diverticulum Viral URI No aspiration No follow up required Viral URI Symptomatic management

references http://www.merckmanuals.com/professional/gastrointestinal- disorders/esophageal-and-swallowing-disorders/esophageal-diverticula http://www.radiologyassistant.nl/en/p440bca82f1b77/swallowing-disorders- interpretation-of-radiographic-studies.html