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Case of the Week 242

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



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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