Esophageal intramural pseudodiverticulosis is an unusual condition manifested by tiny flask-shaped outpouchings in the wall of the esophagus. The condition was diagnosed in 21 (0.15%) of 14,350 patients undergoing radiologic examinations of the esophagus at our hospitals. The pseudodiverticula were detected only by single-contrast technique in five of 18 patients (28%) who underwent both single- and double-contrast examinations. Thus, thin, low-density barium seems to enter these structures more readily than the high-density barium used for double-contrast esophagography. While most patients reported in the literature have diffuse or segmental pseudodiverticulosis associated with high esophageal strictures, the majority of our patients (11 [52%] of 21) had isolated involvement of the distal esophagus with 10 or fewer pseudodiverticula in the region of a peptic stricture. Other associated conditions included Candida esophagitis, herpes esophagitis, and squamous cell carcinoma of the esophagus. Our experience suggests that pseudodiverticulosis usually represents a sequela of reflux esophagitis, although the reason that so few patients with esophagitis develop this condition is unclear.