Potential threat of pharyngo-esophageal diverticulum to thermal ablation treatment of thyroid nodule and rapid differential diagnosis through swallow contrast-enhanced ultrasonography

Objective To explore the potential risk of misdiagnosis of pharyngeal esophageal diverticulum(PED) for the treatment of thyroid nodules with thermal ablation and its rapid and effective method of diagnosis. Methods The process of diagnosis and treatment were reviewed on 5 cases of PEDs which had been misdiagnosed as thyroid nodules and recommended for thermal ablation therapy. A comprehensive analysis was carried out for the reasons of misdiagnosis, the timing and clues of the diagnosis as well as the advantage of swallow contrast-enhanced ultrasonography(sCEUS) in achieving rapid and correct diagnosis. Results The lack of recognition and vigilance to the acoustic image of PED were the direct causes of misdiagnosis. Five cases of PED misdiagnosed as thyroid nodules were all discovered by the same chief operator before thermal ablation. They were confirmed through sCEUS and mistreatment by ablation were fortunately avoided, but all true thyroid nodules requiring treatment were safely ablated. Conclusions PED is easily misdiagnosed as thyroid nodule.Improving the recognition and vigilance of the ultrasonic features of PED, strictly implementing the reconfirming ultrasound examination by the chief operator, and promptly conducting sCEUS are sensible measures to quickly correct the diagnosis and prevent wrong ablation of PED. Key words: Contrast-enhanced ultrasonography; Thermal ablation; Pharyngo-esophageal diverticulum; Thyroid nodule; Differential diagnosis