Easier to Swallow: Pictorial Review of Structural Findings of the Pharynx at Barium Pharyngography

Abstract

Barium pharyngography remains an important diagnostic tool in the evaluation of patients with dysphagia. Pharyngography can not only help detect functional abnormalities but also help identify a wide spectrum of structural abnormalities in children and adults. These structural abnormalities may reflect malignant or nonmalignant oropharyngeal, hypopharyngeal, or laryngeal processes that deform or alter normal coated mucosal surfaces. Therefore, an understanding of the normal appearance of the pharynx at contrast material-enhanced imaging is necessary for accurate detection and interpretation of abnormal findings. Congenital malformations are more typically identified in the younger population; inflammatory and infiltrative diseases, trauma, foreign bodies, and laryngeal cysts can be seen in all age groups; and Zenker and Killian-Jamieson diverticula tend to occur in the older population. Squamous cell carcinoma is by far the most common malignant process, with contrast-enhanced imaging findings that depend on tumor location and morphology. Treatments of head and neck cancers include total laryngectomy and radiation therapy, both of which alter normal anatomy. Patients are usually evaluated immediately after laryngectomy to detect complications such as fistulas; later, pharyngography is useful for identifying and characterizing strictures. Deviation from the expected posttreatment appearance, such as irregular narrowing or mucosal nodularity, should prompt direct visualization to evaluate for recurrence. Contrast-enhanced imaging of the pharynx is commonly used in patients who present with dysphagia, and radiologists should be familiar with the barium pharyngographic appearance of the normal pharyngeal anatomy and of some of the processes that alter normal anatomy.

A rare case of laryngeal cleft in association with VACTERL and malrotation

“…Computed tomography imaging may be useful in visualizing a direct communication between the trachea and esophagus; however, an esophagram is most useful in evaluating laryngeal clefts and distinguishing them from tracheoesophageal fistulas [ [2] , [5] ]. Isolated tracheoesophageal fistulas without esophageal atresia, also known has H- or N-type fistulas, have a narrow connection between the trachea and esophagus that is sometimes only seen while the patient is in the prone position.…”

Air column beside the trachea

“…A barium swallow can allow visualisation of the outpouching from the pharynx (in case of a pharyngeal diverticulum). At barium pharyngography, Zenker's diverticula are usually located in the midline or slightly to the left of midline on anteroposterior images, and extend posteriorly and inferiorly on lateral images 8. Pharyngo-oesophagoscopy may be used for direct visualisation of the communication of air sac with pharynx or oesophagus.…”

Imaging of the oesophagus: beyond cancer

“…Patients with these diverticula can be asymptomatic or suffer a range of symptoms including dysphagia, chronic cough, and regurgitation of food [32]. On barium esophagram, a Zenker diverticulum will present as a midline posterior oesophageal outpouching which will pool oral contrast.…”

“…In contrast to Zenker diverticula, Killian-Jamieson diverticula protrude laterally through the anterolateral wall [32, 33]. They are less common than Zenker diverticula.…”