Which of the following statement(s) is/are true concerning esophageal diverticula?

b. Mediastinal granulomatous disease usually results in a mid-esophageal traction diverticulum which is usually asymptomatic

c. An epiphrenic diverticulum that presents to the right of the esophagus should be managed via left thoracotomy

d. Minimally symptomatic epiphrenic diverticula should not be operated upon 

An esophageal diverticulum is an epithelial-lined mucosal pouch that protrudes from the esophageal lumen. Most esophageal diverticula are acquired, and occur predominantly in adults. The pharyngoesophageal (Zenker’s diverticulum) is the most common esophageal diverticulum and typically occurs in patients between 30 and 50 years of age. Mediastinal granulomatous disease (e.g., tuberculosis or histoplasmosis) is the most common cause of mid-esophageal traction diverticulum. This type of diverticulum is much smaller than the pulsion diverticulum and has a characteristic blunt tapered tip that points toward the adjacent subcarinal or peribronchial lymph nodes to which it adheres. It is typically diagnosed as an incidental finding on a barium esophogram and is almost always asymptomatic. No specific treatment is indicated. An epiphrenic or supradiaphragmatic diverticulum occurs within the distal 10 cm of the thoracic esophagus as a pulsion diverticulum that arises because of abnormally elevated intraluminal esophageal pressure. Although many patients are asymptomatic at the time of diagnosis on barium esophogram, others have symptoms from the frequently associated esophageal conditions: hiatal hernia, diffuse esophageal spasm, achalasia, reflux esophagitis and carcinoma. Pouches smaller than 3 cm and causing little or no symptoms require no treatment. Severe dysphagia, chest pain, or an anatomically dependent or enlarging pouch are indications for repair. The surgical approach to an epiphrenic diverticula is through a left 6th or 7th interspace posterolateral thoracotomy. This is the case even for diverticula that present to the right of the esophagus.