title: Zenker's diverticulum associated with multilevel cervical osteomyelitis.
abstract: METHODS
  A case report of cervical osteomyelitis possibly associated with a Zenker's diverticulum perforation.
  
  
  OBJECTIVE
  To present clinical, radiologic, and surgical findings of a cervical osteomyelitis due to a Zenker's diverticulum perforation.
  
  
  BACKGROUND
  A 56-year-old patient was in an intensive care unit for a severe head injury. He was fed via a nasogastric tube. Four months later he developed a pyogenic cervical vertebral infection.
  
  
  METHODS
  Plain films and magnetic resonance imaging showed a diffuse cervical osteomyelitis. Investigation of his dysphagia revealed a Zenker's diverticulum.
  
  
  RESULTS
  After administration of antibiotics and surgical treatment of the diverticulum, the cervical infection resolved. Plain films and magnetic resonance imaging showed healing with vertebral fusion.
  
  
  CONCLUSIONS
  Cervical osteomyelitis is uncommon. Only one case of direct contamination leading to cervical vertebral osteomyelitis after esophageal perforation has been previously described. Direct contamination of the prevertebral soft tissues by bacteria traveling through the fistula may have occurred. The development of vertebral osteomyelitis in this case is consistent with the hypothesis of direct contamination. Management relies on appropriate antimicrobial therapy and surgical management of the diverticulum. The association of Zenker's diverticulum with vertebral osteomyelitis and discitis is a unique, previously undescribed situation.
authors.affiliation: Department of Radiology, Raymond Poincaré Hospital, Garches, France.
authors.forename: B
authors.initials: B
authors.lastname: Frot-Martin
authors.forename: R Y
authors.initials: RY
authors.lastname: Carlier
authors.forename: V
authors.initials: V
authors.lastname: Morand-Blot
authors.forename: A
authors.initials: A
authors.lastname: Faye
authors.forename: L
authors.initials: L
authors.lastname: Bernard
authors.forename: C
authors.initials: C
authors.lastname: Vallée
mesh_terms: D000890:Anti-Infective Agents; D000904:Antibiotics, Antitubercular / Q000627:therapeutic use; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000473:pathology; D005402:Fistula / Q000150:complications; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D015242:Ofloxacin / Q000627:therapeutic use; D010019:Osteomyelitis / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D012293:Rifampin / Q000627:therapeutic use; D013122:Spinal Diseases / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D013492:Suppuration; D014057:Tomography, X-Ray Computed; D016672:Zenker Diverticulum / Q000150:complications* / Q000601:surgery
chemical_list: D000890:Anti-Infective Agents; D000904:Antibiotics, Antitubercular; D015242:Ofloxacin; D012293:Rifampin