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doi:10.1111/jgh.12762
E D U C AT I O N A N D I M A G I N G
Gastrointestinal: Esophageal traction diverticulum led to tuberculosis diagnosis
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broad-based traction diverticulum from the mid-esophagus (Fig. 2). Further history revealed that he had travelled to Kenya at the age of 10 months and become ill with coughing and night sweats. He improved without any specific treatment. Apart from abdominal pain, he remained well, but his father reported reduced exercise tolerance and occasional night sweats in the 3 months prior to presentation. A QuantiFERON-TB Gold In-Tube assay (Qiagen, Venlo, Limburg, The Netherlands) was strongly positive (> 10 IU/mL). A chest radiograph showed small foci of calcification in the right hilum region. A chest computed tomography (Fig. 3) confirmed widespread calcifications consistent with tuberculosis (TB). He was started on antituberculous treatment with symptom resolution within 4 weeks. Esophageal diverticula in children are rare and are typically classified as congenital, pulsion, or traction diverticula. Pulsion diverticula are associated with esophageal dysmotility, esophageal wall weakness, or obstruction of the lumen. Progressive fibrosis of the paraesophageal lymph nodes following a granulomatous infection can result in a traction diverticulum. Traction diverticula have been described in the setting of TB but are relatively rare even in endemic areas. These are usually asymptomatic but can present with epigastric pain and dysphagia, together with constitutional symptoms of TB. The differential diagnosis includes histoplasmosis, anthracosis, sarcoidosis, silicosis, amyloidosis, and Castleman disease. Uncomplicated traction diverticula do not require any specific treatment.
A 3-year-old boy of African descent had a gastroscopy for a 6-month history of recurrent abdominal pain. A small unusual wide-based pit was noted in the lower esophagus (Fig. 1). An upper gastrointestinal contrast study confirmed the presence of a
1850
Contributed by A Meyer,* T Connell† and G Alex* *Department of Gastroenterology and Nutrition, and † Infectious Diseases Unit and Department of General Medicine, Royal Children’s Hospital, Melbourne, Victoria, Australia
Journal of Gastroenterology and Hepatology 29 (2014) 1850 © 2014 Journal of Gastroenterology and Hepatology Foundation and Wiley Publishing Asia Pty Ltd
Copyright of Journal of Gastroenterology & Hepatology is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
doi:10.1111/jgh.12762
E D U C AT I O N A N D I M A G I N G
Gastrointestinal: Esophageal traction diverticulum led to tuberculosis diagnosis
Figure 1
Figure 3
Figure 2
broad-based traction diverticulum from the mid-esophagus (Fig. 2). Further history revealed that he had travelled to Kenya at the age of 10 months and become ill with coughing and night sweats. He improved without any specific treatment. Apart from abdominal pain, he remained well, but his father reported reduced exercise tolerance and occasional night sweats in the 3 months prior to presentation. A QuantiFERON-TB Gold In-Tube assay (Qiagen, Venlo, Limburg, The Netherlands) was strongly positive (> 10 IU/mL). A chest radiograph showed small foci of calcification in the right hilum region. A chest computed tomography (Fig. 3) confirmed widespread calcifications consistent with tuberculosis (TB). He was started on antituberculous treatment with symptom resolution within 4 weeks. Esophageal diverticula in children are rare and are typically classified as congenital, pulsion, or traction diverticula. Pulsion diverticula are associated with esophageal dysmotility, esophageal wall weakness, or obstruction of the lumen. Progressive fibrosis of the paraesophageal lymph nodes following a granulomatous infection can result in a traction diverticulum. Traction diverticula have been described in the setting of TB but are relatively rare even in endemic areas. These are usually asymptomatic but can present with epigastric pain and dysphagia, together with constitutional symptoms of TB. The differential diagnosis includes histoplasmosis, anthracosis, sarcoidosis, silicosis, amyloidosis, and Castleman disease. Uncomplicated traction diverticula do not require any specific treatment.
A 3-year-old boy of African descent had a gastroscopy for a 6-month history of recurrent abdominal pain. A small unusual wide-based pit was noted in the lower esophagus (Fig. 1). An upper gastrointestinal contrast study confirmed the presence of a
1850
Contributed by A Meyer,* T Connell† and G Alex* *Department of Gastroenterology and Nutrition, and † Infectious Diseases Unit and Department of General Medicine, Royal Children’s Hospital, Melbourne, Victoria, Australia
Journal of Gastroenterology and Hepatology 29 (2014) 1850 © 2014 Journal of Gastroenterology and Hepatology Foundation and Wiley Publishing Asia Pty Ltd
Copyright of Journal of Gastroenterology & Hepatology is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
![[Meckel's diverticulum and lower gastrointestinal bleeding. Problems of preoperative diagnosis].](/assets/img/hold.png)
