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Esophageal diverticulum presenting as metastatic thyroid mass on iodine-131 scintigraphy.

A follow-up 1-131 whole-body scintigram performed on a 56-year-old man 2 years after total thyroidectomy and ablation therapy with radioactive 1-131 for papillary thyroid carcinoma showed focal midline uptake in the anterior neck compatible with thyroid remnant tissue or metastatic papillary carcinoma. The activity largely dissipated on additional "postwash" imaging after fluid ingestion, indicating accumulation of activity most likely in the patient's known Zenker diverticulum rather than thyroidal tissue. The possibility of a false-positive study resulting from related conditions needs to be considered for proper interpretation. Radiographic correlation helps differentiate a functional thyroid remnant from physiological or false-positive findings.