Real-time sonography of Killian-Jamieson diverticulum and its differentiation from thyroid nodules

Killian-Jamieson and Zenker diverticula are both rare pharyngoesophageal diverticula. Both are outpouching of the mucosal and submucosal layers of the esophageal wall, which protrude through a muscular gap at the level of the pharyngoesophageal esophagus. When these diverticula are large enough, they can be in proximity to the thyroid gland and may mimic a thyroid nodule. Thyroid nodules, although shown well by high-resolution sonography, cannot be finally diagnosed by imaging modalities; therefore, most of them are further investigated with fine-needle aspiration (FNA). To our knowledge, 7 previous case reports of Zenker diverticulum diagnosed by sonography are reported in the literature. There is no report regarding the sonographic diagnosis of Killian-Jamieson diverticulum. Both can be mistaken for a thyroid nodule. Our purpose is to focus radiologists' attention on the possibility of a pseudo thyroid lesion originating in the esophagus and to describe the sonographic findings and advantages of real-time sonography in examining the thyroid to reach the correct diagnosis and avoid unnecessary invasive and possible dangerous procedures.