Pharyngeal dysphagia: what the radiologist needs to know

Area of Science:

• Radiology
• Gastroenterology
• Otolaryngology

Background:

• Dysphagia, difficulty swallowing, impacts the oropharynx and hypopharynx.
• Oropharyngeal dysphagia specifically involves impaired bolus transit from mouth to esophagus.
• Accurate diagnosis is crucial for effective management of swallowing disorders.

Purpose of the Study:

• To review radiographic findings of normal and abnormal pharyngeal anatomy in dysphagia.
• To highlight common and challenging diagnoses in oropharyngeal dysphagia evaluation.
• To guide radiologists in interpreting barium studies for swallowing difficulties.

Main Methods:

• Barium studies (including double-contrast views) are the primary imaging modality.
• Evaluation of pharyngeal and hypopharyngeal motility.
• Identification of structural and mucosal abnormalities.

Main Results:

• Barium studies readily identify pharyngeal diverticula (e.g., Zenker's), cervical webs, and pharyngeal pouches.
• Distinguishing abnormalities from normal anatomy and postoperative changes is emphasized.
• Radiographic features of lingual hyperplasia, squamous carcinoma, retention cysts, extrinsic tumors, and osteophytes are discussed.

Conclusions:

• Barium studies are essential for diagnosing oropharyngeal dysphagia and associated structural abnormalities.
• Radiologists must be adept at recognizing diverse pharyngeal pathologies and differentiating them from normal findings.
• Comprehensive understanding of pharyngeal anatomy and pathology on imaging improves diagnostic accuracy for swallowing disorders.