1 隈病院臨床検査科Department of Clinical Laboratory, Kuma Hospital
2 隈病院外科Department of Surgery, Kuma Hospital
3 隈病院内科Department of Internal Medicine, Kuma Hospital
目的：咽頭食道憩室は超音波検査において，甲状腺とは別個の物体として観察されるだけではなく，甲状腺結節のように観察されることがあり鑑別が必要な病変である．今回，多数の症例を検討し咽頭食道憩室の超音波所見の特徴と甲状腺との位置関係を明らかにする．
対象と方法: 200X年から201X年の11年間に甲状腺超音波検査を施行した当院初診の症例のうち，咽頭食道憩室と判断した症例を対象とした．大きさ，境界，甲状腺との位置関係，内部構造，血流シグナルと嚥下動作時の超音波所見を検討した．
結果と考察：初診症例152,365例のうち151例（≒0.1%）に咽頭食道憩室を認めた．大きさの平均18 mm，楕円形，位置は左側138例（91.4%），右側13例（8.6%），甲状腺側の境界は明瞭平滑で，一層の低エコー帯がみられ，背面側の境界は欠如か観察されず，内部の血流シグナルは認めなかった．甲状腺との位置関係では，埋没型（甲状腺内に大半が埋没）は78例（51.6%），中間型（甲状腺内に約半分が埋没）は62例（41.1%），非埋没型（甲状腺内には埋没せず背側から押し上げる）は11例（7.3%）であった．嚥下動作時に，憩室は甲状腺とは異なる動きを示し，甲状腺側の低エコー層は尾側の食道の粘膜層に繋がることが観察された．
結語：咽頭食道憩室は超音波検査において，甲状腺内に埋没し甲状腺結節のように描出される症例が多数を占めている．頸部・甲状腺超音波検査に携わる者はこのことを十分に知っておく必要がある．
Purpose: Pharyngoesophageal diverticula may be imaged by cervical ultrasonography as they tend to be located in the inside or on the outside of the thyroid gland. The purpose of this study is to clarify the ultrasonographic findings of pharyngoesophageal diverticula and their positional relationship to the thyroid gland.
Subjects and Methods: We retrospectively analyzed cervical ultrasound examinations performed at our hospital during an 11-year period, from 200X to 201X, on newly admitted patients with suspicion of thyroid disease. We reviewed ultrasonographic findings such as size, border characteristics, internal structure, blood stream Doppler signals, positional relationship to the thyroid, and swallowing motion.
Results and Discussion: Of the total 152,365 patients involved in this study, 151 patients were diagnosed with a pharyngoesophageal diverticulum (≈0.1%). Ultrasonographic imaging characterized diverticula as 18 mm in size, on the left side in the majority of the patients, with a clear and smooth border, thin hypoechoic layer on the side of the thyroid, lack of border on the back side, many internal hyperechoic spots (linear and disseminated), and a deficiency of internal bloodstream Doppler signals. Based on their positional relationship to the thyroid, these diverticula were classified into three types: (1) buried (majority buried in the thyroid), 78 patients (51.6%); (2) intermediate (half-buried in the thyroid), 62 patients (41.1%); and (3) not buried (push-up the thyroid and not buried), 11 patients (7.3%).
Motion ultrasonography at the time of swallowing saliva showed that saliva did not enter inside, diverticula did not move along with the thyroid, and a thin hypoechoic layer of the diverticula was connected to the mucous membrane of the caudal portion of the esophagus.
Conclusion: Upon performing ultrasonography, the majority of pharyngoesophageal diverticula were found to be buried in the thyroid as a “thyroid nodule.” Examiners who perform cervical or thyroid ultrasonography should pay close attention to this fact.
Key words: diverticulum; esophagus; thyroid; ultrasonography; diagnosis
© 2021 一般社団法人日本超音波検査学会© 2021 Japanese Society of Sonographers
This page was created on 2021-03-22T15:41:04.748+09:00
This page was last modified on 2021-05-06T07:55:54.000+09:00
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