Abstract
We discuss an unusual presentation of Zenker's Diverticulum (ZD). A 76-year-old man presented with a left sided neck mass which was misdiagnosed as a thyroid mass due to the anatomical location and size. The ultrasound and fine needle-aspiration cytology findings were inconclusive, and a CT scan was then considered which reported a large pharyngeal pouch. Our recommendation is to consider an early CT scan in patient's where there is a clinical suspicion or risk factors for the development of pharyngeal pouch specially when the fine-needle aspiration cytology findings are inconclusive. This would reduce the risk of a delayed diagnosis which can prevent potential perforation of the pharyngeal pouch and development of mediastinitis.