A 41 year old professional bodybuilder presented with worsening dysphagia and regurgitation.
Neck examination and flexible nasolaryngoscopy were unremarkable, but a barium swallow showed an unusual wide mouthed and bilobed pharyngeal pouch.
A pharyngeal pouch (or Zenker’s diverticulum) characteristically occurs just above the cricopharyngeus muscle at an area of potential weakness.
Although more common in older patients, pouches can occur in younger patients with chronically increased intrapharyngeal pressure, such as glass blowers and trumpet players.
The bodybuilder had developed a weightlifting technique that involved blowing his cheeks out and greatly increasing intrapharyngeal pressure.
Source: BMJ 2013;346:f1677.