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Modified Mondays: Zenker’s - Seeing Double?

Updated: Dec 19, 2022

After 20 years and thousands of swallow studies, you would assume I would have a pretty good idea of what to expect when the fluoro comes on. The truth is.. the more studies I do, the more I realize how very necessary they are (and why I will never stop saying that instrumental assessment is crucial). This week’s share is a great example.

This patient presented with cough post swallow, a “wet gurgly voice” which improved with cough and reswallow. Clinically, it could be an odds on that the patient has residue after the swallow, with subsequent aspiration or penetration that resulted in a cough, and maybe the patient was able to clear. Maybe we could recommend some exercises to improve clear of the residues, or strategies. In this case, the facility SLP recommended an MBS study, and we found a pretty rare bilobed Zenker’s diverticulum (watch until the end for the best view). We made the referral to ENT and GI for diagnosis and further work up.

This is obviously a rare finding-not something we could guess or even have a good differential theory on clinically. We can definitely argue that it’s reasonable to go with the odds most of the time, but these findings show us that eventually the odds can catch up with our patients-we need clinical swallow assessments, but we also need to think very critically about the findings when making recommendations.

See the case study below for some information on bilobed Zenker’s-there are some really great images in this article in particular.

Please check out our previous posts for other great Zenker’s examples and more information on this type of diverticulum.

bilobed-zenker-diverticula.pdf (

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