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Modified Monday: Pharygocele

Today’s Modified Monday features a pharyngocele. A pharyngocele is a diverticulum on the lateral wall of the pharynx typically seen towards the aryepiglottic fold area/pyriform sinus recess. Most people don’t have any symptoms from this little pocket in their throat, but there are some who have dysphagia, neck swelling, sore throat, dysphonia, regurgitation, or weight loss. Pharyngoceles are caused by an increase of pharyngeal pressure (sometimes from playing wind instruments, glass blowing, or chronic coughing) and weakened pharyngeal constrictors.

The patient you will see in the video today was completely unaware of the pharyngocele and it did not contribute to any functional swallowing issue. Initially, in the video you will see a coating on the aryepiglottic fold with the thin liquid. It isn’t apparent that there is a diverticulum until multiple presentations of thin are given. In addition, the pharyngocele is not seen with the nectar thick liquid or puree. These consistencies did not flow into the pocket as well as the thin liquid. This is similar to how an esophageal web is more evident with thin liquids than with other consistencies. With the AP view, at the end of the test, there is a different perspective of the pharyngocele with clear demonstration that it is unilateral.

Pharyngoceles tend to be over-diagnosed. Misdiagnosis seems to occur more often when the aryepiglottic folds are pendulous and there is more residue retained on them, almost appearing like pockets. A glimpse in AP view can help discern if a pharyngocele is present.

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