Int J Thyroidol.  2022 Nov;15(2):135-139. 10.11106/ijt.2022.15.2.135.

A Case of Papillary Thyroid Carcinoma Accompanied by Zenker’s Diverticulum: Considerations for Surgery

Affiliations
  • 1Department of Otolaryngology, Head and Neck Surgery, Kosin University College of Medicine, Busan, Korea

Abstract

Zenker’s diverticulum is rarely known to be an impediment to the diagnosis and surgical procedure for thyroid disease. In this report, we discuss a rare case of pre-operative diagnosis of asymptomatic Zenker’s diverticulum and surgical treatment of the disease during thyroidectomy. A 48-year-old male was referred to our hospital with multiple thyroid nodules confirmed to be papillary thyroid cancer. Pre-operative ultrasonography and computed tomography scan findings suggested the presence of a left Zenker’s diverticulum. The left pharyngeal pouch was treated by reinforcing the overlying soft tissue during thyroidectomy, without structural injury to the recurrent laryngeal nerve. We report this case with a focus on the considerations during the pre-operative diagnosis and precautions to be taken during surgery, such as the distorted path of the recurrent laryngeal nerve and manipulation of the diverticulum.

Keyword

Thyroid cancer; papillary; Zenker diverticulum; Recurrent laryngeal nerve; Intraoperative neurophysiological monitoring

Figure

  • Fig. 1 Pre-operative axial (A) and sagittal (B) plane of cervical ultrasonography showing a 1.4×1.0 cm-sized nodule suspected of Zenker’s diverticulum with a halo, and heterogeneous internal echogenicity with posterior acoustic shadowing.

  • Fig. 2 Pre-operative CT scan showing soft tissue density (indicating the presence of a 1.0×0.9 cm-sized mass suspected of Zenker’s diverticulum) with multi-focal air shadows, adjacent to the left thyroid lobe and esophagus.

  • Fig. 3 Intraoperative images showing the recurrent laryngeal nerve (double arrows) and Zenker’s diverticulum (arrow) after left hemi-thyroidectomy and modified radical neck dissection.

  • Fig. 4 Intraoperative images showing the recurrent laryngeal nerve (double arrows) and revised Zenker’s diverticulum (arrow).


Reference

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