Thyroid Pseudo-Nodules 101: Zenker’s Diverticulum ZD Looks like a Thyroid Nodule. When a Zenker’s is in the neck next to the thyroid it is rare location in the neck called Killian-Jamieson KJ Diverticulum.
59 Y/O referred for possible RFA ablation of a left sided solid thyroid nodule.
Neck MR incidental finding a “thyroid Nodule”
PE Visible and palpable nodule left lobe. US Unusual mass with separation from the thyroid lobe on the left.
TFT’s were all normal except borderline TPO 10 N=<9.
Ultrasound calcified mass with clear separation line from the thyroid lobe.
FNA no thyroid cells only normal squamous cells debris, and filamentous elements.
The mostly likely cause was a KJ pouch in the neck next to the thyroid gland.. She denied any cough foul smelling breath or but recently vomited food when there was no reason. She also had trouble swallowing large pieces of meat or food as it would stick in the neck.She added that “sometimes I felt like there were bubbles in the lump in my neck.”
Cine-esophagram confirmed a pouch off the esophagus. This was a KJ Diverticulum.
The pouch seen pushing against the barium column and forming a half circle was in the exact location of the so called thyroid nodule on ultrasound.
Large pouch seen in the neck on the left.
Overlay of the thyroid gland showing the pouch in the position of a left thyroid nodule. Rare KJ pouch off the esophagus always fools the referring physician to send the patient for a thyroid biopsy.
A second case was sent to me because the physician thought the radiologist missed the thyroid nodule and stuck the needle into the esophagus by mistake. He wanted me to do a proper thyroid nodule biopsy. Review of the US found separation of the mass from the thyroid gland similar to the first case.The first biopsy I found meat fibers. Cine-esophagram confirmed a Killian-Jamieson KJ diverticulum.
Treating either one as a thyroid nodule would have been big trouble. Endoscopic treatment is needed not thyroid surgery or radiofrequency or ethanol ablation.
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