Sarcoidosis Causing Mid-Esophageal Traction Diverticulum

A 78-year-old man presented to the outpatient clinic with progressive dysphagia with solid food for a few years. He had the feeling that food got stuck in his chest when swallowing. He denied any fevers, unintentional weight loss, hemoptysis, sore throat, odynophagia, shortness of breath, or wheezing. On examination he was hemodynamically stable. Chest exam revealed lower left lung crackles. He reported a medical history of bronchial asthma, allergic rhinitis, pulmonary hypertension, and sarcoidosis. Sarcoidosis was diagnosed in 2007 when he presented with a face lesion proved to be lupus pernio by skin biopsy (Figure 1). Computed tomography scan of the chest in 2012 after an asthma attack was concerning for bilateral pulmonary stellate opacities, pleural-based opacities, and mediastinal and hilar lymphadenopathy. Infrared-guided biopsy obtained at that time showed histological findings of sarcoidosis (Figure 2). Esophagram showed an esophageal diverticulum in mid-esophagus measuring 1.5 cm in diameter (Figure 3). Absence of esophageal motility abnormality and presence of lung andmediastinal lymph node fibrosis noted with radiological and histological means indicated a diagnosis of traction mid-esophageal diverticulum. Despite the presence of symptoms, the patient was a poor surgical candidate.