![]() ![]() The diverticula are lined by nonkeratinizing squamous epithelium surrounded by loose areolar connective tissue, with many vascular spaces. In contrast, lateral pharyngeal diverticula are persistent protrusions of pharyngeal mucosa, usually through the thyrohyoid membrane or, rarely, through the tonsillar fossa. The pouches protrude through the region of the thyrohyoid membrane. Barium is retained in the right and left lateral pharyngeal pouches ( arrows ). This delayed spill may result in dysphagia or a choking sensation because of overflow aspiration.įrontal view of the pharynx obtained as the bolus is passing through the lower pharynx and pharyngoesophageal segment. Barium that is retained in pouches during swallowing spills into the ipsilateral piriform sinus after the bolus passes. On lateral views, the pouches are seen as oval ring shadows (occasionally with an air-contrast level) below the hyoid bone at the level of the valleculae, just behind the epiglottic plate, along the anterior hypopharyngeal wall. On double-contrast frontal views in which a modified Valsalva maneuver is performed, the pouches are seen as hemispheric, barium-coated protrusions above the notch in the lateral pharyngeal wall. The junction of the ala of the thyroid cartilage and thyrohyoid membrane is seen on frontal views as a notch in the lateral pharyngeal wall. On frontal views during swallowing, pouches appear as transient, hemispheric, contrast-filled protrusions from the lateral hypopharyngeal wall, below the hyoid bone and above the calcified edge of the thyroid cartilage ( Fig. Lateral pharyngeal pouches are extremely common, and the frequency of their occurrence increases with age. Approximately 5% of people with lateral pharyngeal pouches complain of dysphagia, choking, or regurgitation of undigested food. ![]() Patients with lateral pharyngeal pouches usually have no symptoms. This unsupported part of the thyrohyoid membrane is perforated by the superior laryngeal artery and vein and the internal laryngeal branch of the superior laryngeal nerve. This region is bounded superiorly by the greater cornu of the hyoid bone, anteriorly by the thyrohyoid muscle, posteriorly by the superior cornu of the thyroid cartilage and stylopharyngeal muscle, and inferiorly by the ala of the thyroid cartilage. The upper anterolateral pharyngeal wall is poorly supported in the region of the posterior and superior portions of the thyrohyoid membrane. The lateral pharyngeal wall may protrude beyond the normal expected contour of the pharynx in areas unsupported by muscle layers. Lateral Pharyngeal Pouches and Diverticula ![]()
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