Image of an Unusual Thyroid Nodule

Abstract

A CT scan of the neck was performed, which showed a lesion contiguous with the esophagus and with presence of air centrally, features suggestive of a Killian-Jamieson diverticulum (KJD). She was subsequently referred for an esophagogastroduodenoscopy for further evaluation. KJD is an uncommon form of esophageal diverticulum resulting from herniation through a weakness in the anterolateral wall of the proximal cervical esophagus, just caudal of the cricopharyngeus. Its incidence is about 0.025% of the population, typically affecting the elderly,1 and could initially be mistaken for a thyroid nodule,2,3 due to the proximity of the upper esophagus to the thyroid gland. Due to presence of food particles and air bubbles within the diverticulum, a heterogeneous internal echo with strong echogenic foci may be seen on ultrasound and may be mistaken to be suspicious microcalcifications of thyroid cancer. Observing for changes of the size and contents of the lesion during swallowing of water or compression with the ultrasound probe can help to raise suspicion that the nodule is not of thyroid origin.3 ca s e De s c r i p t i o n