Which of the following is investigation of choice for Zenker’s diveiculum?
**Core Concept**
Zenker's diverticulum is a type of esophageal diverticulum that occurs in the upper esophagus, specifically at the cricopharyngeal junction. It is a congenital or acquired condition characterized by the herniation of the mucosa and submucosa through a weakness in the muscular wall of the pharynx.
**Why the Correct Answer is Right**
The investigation of choice for Zenker's diverticulum is barium swallow, also known as esophagram. This imaging technique involves the ingestion of a barium sulfate solution, which coats the esophageal mucosa and provides a clear visual representation of the esophagus on X-ray. In the case of Zenker's diverticulum, the barium will accumulate in the diverticulum, allowing for its clear visualization. The barium swallow is a sensitive and specific test for diagnosing Zenker's diverticulum, and it is often used as a first-line diagnostic tool.
**Why Each Wrong Option is Incorrect**
**Option A:** Endoscopy is not the investigation of choice for Zenker's diverticulum, although it may be used in conjunction with barium swallow to assess the mucosal lining of the diverticulum. Endoscopy may not always visualize the diverticulum, especially if it is small or has a narrow neck.
**Option B:** CT scan is not typically used as a first-line diagnostic tool for Zenker's diverticulum. While it may provide additional information about the size and location of the diverticulum, it is not as sensitive or specific as barium swallow.
**Option C:** Manometry is a test that measures the pressure and function of the esophagus, but it is not typically used to diagnose Zenker's diverticulum. Manometry may be used to assess the function of the pharynx and upper esophagus, but it is not a primary diagnostic tool for this condition.
**Clinical Pearl / High-Yield Fact**
It is essential to note that Zenker's diverticulum is often associated with dysphagia, regurgitation, and aspiration. Patients may also experience symptoms such as halitosis, drooling, and a feeling of food getting stuck in the throat. A high index of suspicion is necessary to diagnose this condition, as symptoms may be nonspecific and overlap with other esophageal disorders.
**Correct Answer:** B. Barium swallow.