title: Feasibility and usefulness of using swallow contrast-enhanced ultrasound to diagnose Zenker's diverticulum: preliminary results.
abstract: Zenker's diverticulum (ZD) may be misdiagnosed on conventional ultrasound as a thyroid nodule or other lesion. A barium esophagram is usually used to confirm the diagnosis; however, this procedure exposes the patient to radiation. The aim of this study was to evaluate the feasibility of using swallow contrast-enhanced ultrasound (swallow-CEUS) to diagnose ZD. Ten consecutive patients with ZD (7 men and 3 women, aged 67 ± 11 y) were included in the study. In 4 patients, ZD was incidentally found on head and neck ultrasound, and in 6 patients, ZD was suspected because of dysphagia. All lesions could be detected on conventional ultrasound before swallow-CEUS. Ten healthy volunteers (8 men and 2 women, aged 60 ± 12 y) were chosen as a control group. Written informed consent was obtained. With the patient in the sitting or upright position, conventional ultrasound was performed first to image the lesion, then the patient was asked to swallow ultrasound contrast agent (UCA) (2-4 drops of SonoVue diluted with about 200 mL of tap water). Transity of the contrast agent in the esophagus was imaged with CEUS. Retention of the UCA in the diverticulum was monitored for at least 3 min. All patients underwent a barium esophagram as the gold standard. Swallow-CEUS revealed that in all patients (100%), the UCA was transported from the pharynx to the esophagus while the patient swallowed. ZD appeared as a pouch-shaped structure at the posterior pharyngo-esophageal junction that retained UCA longer than 3 min. The barium esophagram confirmed the diagnosis of ZD in all patients. For the 10 volunteers, no abnormal structure (retaining UCA) was detected during or after swallowing of UCA. With the advantages of no radiation and bedside availability, swallow-CEUS may become a method of choice in confirmation of the diagnosis of ZD, especially when ZD is suspected on conventional ultrasound.
authors.affiliation: Sino-German Research Center on Ultrasound in Medicine, The First Affiliated Hospital of Zhengzhou University, China; Medical Department 2, Caritas-Krankenhaus Bad Mergentheim, Academic Teaching Hospital of the University of Würzburg, Würzburg, Germany.
authors.forename: Xin-Wu
authors.initials: XW
authors.lastname: Cui
authors.affiliation: Medical Department 2, Caritas-Krankenhaus Bad Mergentheim, Academic Teaching Hospital of the University of Würzburg, Würzburg, Germany.
authors.forename: Andre
authors.initials: A
authors.lastname: Ignee
authors.affiliation: Department of Radiology, Caritas-Krankenhaus Bad Mergentheim, Academic Teaching Hospital of the University of Würzburg, Würzburg, Germany.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Baum
authors.affiliation: Sino-German Research Center on Ultrasound in Medicine, The First Affiliated Hospital of Zhengzhou University, China; Medical Department 2, Caritas-Krankenhaus Bad Mergentheim, Academic Teaching Hospital of the University of Würzburg, Würzburg, Germany. Electronic address: christoph.dietrich@ckbm.de.
authors.forename: Christoph F
authors.initials: CF
authors.lastname: Dietrich
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003287:Contrast Media / Q000008:administration & dosage*; D003679:Deglutition; D004947:Esophagus / Q000000981:diagnostic imaging; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010743:Phospholipids / Q000008:administration & dosage*; D015203:Reproducibility of Results; D013459:Sulfur Hexafluoride / Q000008:administration & dosage*; D014463:Ultrasonography; D016672:Zenker Diverticulum / Q000000981:diagnostic imaging*
chemical_list: D003287:Contrast Media; D010743:Phospholipids; C420843:contrast agent BR1; D013459:Sulfur Hexafluoride
keywords: Contrast-enhanced ultrasound; Diagnosis; Esophagus; Zenker's diverticulum