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

• Lee DW
• Lee HS

• KMID: 2536501
• DOI: http://doi.org/10.11106/ijt.2022.15.2.135

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

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  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.

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  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.

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  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.

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

Reference

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