A case report of a midesophageal diverticulum mimicking a fibrovascular esophageal polyp

INTRODUCTION: Esophageal diverticula and esophageal fibrovascular polyps are uncommon clinical entities. While an asymptomatic presentation is possible, symptoms, when present, may be dissimilar in their gastrointestinal or respiratory characteristics. Additionally, these findings typically occur in different segments of the esophagus, with polyps occurring most frequently in the cervical esophagus and the midesophagus being the predominant location of pathologic diverticula. PRESENTATION OF CASE: We report the case of a 55-year-old patient who presented with a two-year history of progressive dysphagia secondary to a large proximal to midesophageal mass. Workup included esophagography, computed tomography, and endoscopy with ultrasound and was initially consistent with a diagnosis of a large esophageal fibrovascular polyp. Upon operative exploration, the mass was found to be a midesophageal diverticulum associated with a leading lipoma. The patient was successfully treated with transthoracic stapled diverticulectomy. At postoperative follow-up the patient was tolerating oral intake with no symptoms of dysphagia. DISCUSSION: Esophageal diverticula are typically found in the midesophagus and are thought to arise from radial traction secondary to mediastinal inflammation. Esophageal fibrovascular polyps may result from tracheobronchial compression, and esophagography typically identifies a mobile intraluminal mass. CONCLUSION: Esophageal fibrovascular polyps and diverticula are rare, and a high index of suspicion is important in evaluation of these entities.