A 60-year-old woman presents with a lump in the middle of her neck. She is also troubled by regurgitation of her food. On examination, the midline lump gurgles on palpation.

1. What is the most likely diagnosis?
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The diagnosis, in this case, is a pharyngeal pouch.

A pharyngeal pouch is a posteromedial pulsion diverticulum through Killian’s dehiscence. It occurs when there is a herniation between the cricopharyngeus muscle and the thyropharyngeus muscle. These two muscles form part of the inferior constrictor of the pharynx.

2. List four other symptoms that can be associated with this disorder.
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Presenting symptoms include:

  • Dysphagia
  • Regurgitation
  • Chronic cough
  • Weight loss
  • Aspiration
  • Halitosis

There are often no clinical signs, but if there is a palpable lump, it may gurgle on palpation.

3. Which investigation should be avoided?
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Endoscopy should be avoided as perforation could occur.
4. How is this condition treated?
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Surgical intervention may be minimally invasive, involving endoscopic stapling or more invasive treatment for larger pouches.

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