AbstractBackgroundUltrasound is routinely used in evaluating thyroid nodules and performing fine‐needle aspiration cytology (FNAC). Occasionally, nonthyroidal lesions can mimic thyroid nodules on imaging and get wrongly aspirated.MethodsA 63‐year‐old woman was reported to have an incidental left thyroid “nodule” on neck ultrasound scan. It was isoechoic with a surrounding hypoechoic rim and contained tiny foci of echogenicity. Similar findings were noted in a second surgeon‐performed ultrasound scan.ResultsAn ultrasound‐guided FNAC showed abundant squamous cells, bacteria, and vegetable cells with no evidence of thyroid cells or colloid. The suspicion of a pharyngoesophageal diverticulum was confirmed on barium swallow. She remained asymptomatic with no increase in size at 6 months follow‐up.ConclusionA pharyngoesophageal diverticulum can be mistaken for a posteriorly placed “thyroid nodule” on ultrasound scan if the subtle differentiating signs are missed. An awareness of this condition is important to avoid unnecessary needle biopsies. © 2010 Wiley Periodicals, Inc. Head Neck, 2010