This document discusses the anatomy of the pharynx and esophagus. It begins by outlining the gross anatomy, imaging modalities, and subdivisions of the pharynx. It then discusses the introduction, imaging modalities including barium studies and cross-sectional imaging, and vascular and lymphatic anatomy of the esophagus. Key points include that the pharynx is a fibromuscular tube located from the skull base to the level of C6, and the esophagus is a muscular tube that extends from the cricoid cartilage to the stomach at T10. Various imaging modalities can be used to visualize these structures.

1. Anatomy of Pharynx &
Esophagus
BY-Dr. Abduljelil N. (RR-1)
March 29,2019 Gc

2. OUTLINE
§ ANATOMY OF PHARYNX
ØGross anatomy
ØImaging modalities
ØSubdivisions of pharynx
§ ANATOMY OF ESOPHAGUS
ØIntroduction
ØImaging modalities
ØBarium study
ØCross sectional

3. ANATOMY OF PHARYNX
• Fibromascular tube
• skull base -C6 /cricoid cartilage where it
becomes continuous with esophagus
• 12–14 cm in length
• Attached anteriorly and communicates
to the margins of the nasal cavities, oral
cavity, and larynx

4. •

5. Pharyngeal wall
• Three layers: -
ümucosa
üfibrous submucosa
upharyngobasilar
fascia ,
ümuscular layer
(constrictor and
longitudinal )
uBuccopharyngeal
fascia

6. Pharyngeal wall muscles
6

7. Sinus of Morgagni
7

9. Killians Dehiscence / Triangle
•
9

10. Killian-Jamieson(Proximal, lateral cervical
esophageal ) pouches and diverticula

11. Imaging modalities
• Plain films
• Barium swallow
uVideofluoroscopy
• CT
• MRI

12. SUBDIVISIONS OF PHARYNX
12

13. NASOPHARYNX
• Boundaries
Anteriorly : - nasal cavity at
the choane
Inferiorly : - oropharnx at
the level of lower border
of soft palate
Superior :- body of sphenoid
and clivus (adenoid )
Posterior :- anterior arch of
C1 , prevertubral ms
13

14. Internal structures
Ø torus tobarius
Ø rosenmuler fossa
Ø auditory tube opening
Ø pharyngeal tonsil
Ø tubal tonsil
14

15. Cont.....
15

16. OROPHARYNX
• Soft palate – upper
border of epiglottis
• Boundaries
Superior– s.palate and
pharyngeal isthmus
Anterior- opening of oral
cavity & post 1/3rd of
tongue
Posterior – prevetebral
ms , body of C2 and
upper part C3 …
16

17. Lateral wall
• Palatopharyngeal fold
• palatoglossal folds
• palatine tonsils
17

18. Valecullae
Inferior and anterior
indentations of op
• medially - midline glosso-
epiglottic fold
• anteriorly - tongue base
• Laterally pharyngo-
epiglottic folds
• Posteriorly - epiglottis
18

20. HYPOPHARYNX
20

21. Hypopharnx – laterally thyroid C &
thyrohyoid M , pyriform fossa
•
21

22. ANATOMY OF ESOPHAGUS

23. Introduction
• Muscular tube = Cricoid cartilage at C- 6 to cardiac orifice of
stomach T10
• 25 cm in length
• Fibrous,muscular,submucosa &mucosa
• Lined by Stratified Squamous epithelium
• outer longitudinal & inner circular ms
• lacks a serosal layer, which allows the rapid spread of tumor
into adjacent tissues

25. vascular and lymphatic anatomy
Arterial supply and venous drainage
• Upper third – inferior thyroid artery, with drainage into
the inferior thyroid vein.
• Middle third – direct oesophageal branches from the
descending aorta, with drainage into the azygos vein.
• Distal third – oesophageal branches of the left gastric
artery.Drainage into the oesophageal branch of the
left gastric vein which drains into the portal vein. 25

26. 26

27. s
27

28. Lymphatic drainage
Para esophageal lymphatic plexus draining:
• superiorly to the posterior mediastinal lymph
nodes and then into the supraclavicular node
• inferiorly to the left gastric /gastrohepatic and
coeliac lymph nodes
28

29. 29

30. Imaging modalities
• Plain films
• Endoscopic ultrasound
• Barium swallow
• CT&MRI

31. Chest radiography
• Normally esophagus not seen on frontal views
ü azygoesophageal line:- Rt wall of esophagus & azygous vein
as they are outlined by lung
ü pleuroesophageal line:- Above azygous vein (at level of T4) the
pleura abuts the esophageal wall
• on lateral film: posterior to trachea if it contains air
l Air fluid level & distention of esophagus may be seen
in case of pathology
l suspected perforation or
l foreign body
l TEF 31

32. 32

33. Endoscopic ultrasound

34. BARIUM STUDY ANATOMY OF OESOPHAGUS
• main radiological method
• esophageal mucosa - smooth & featureless when
fully distended on air–contrast barium studies
• When not fully distended = multiple longitudinal folds
( 5 ), <3mm in thickness, become evident
• No transverse mucosal folds
early sign of dysmotility or esophagitis if present -feline
esophagus 34

35. Normal longitudinal folds in the esophagus
mucosal relief view of the collapsed esophagus

36. Show three impressions on the oesophagus

37. A and B(Schatzki’s) rings , vestibule
doublecontrast barium study (A) and a singlecontrast barium study (B)

38. Z line
38

39. CROSS SECTIONAL ANATOMY
• Oval , soft tissue density , usually surrounded by fat
• > 60% collapsed - no air , if present should be
located central
Eccentric contrast or air should be considered abnormal
• Distension of upper part > 10mm,or lower part >
20mm is abnormal
• No air fluid level
• The wall of the distended esophagus should not
exceed 3 mm in thickness
• Cervical , thoracic and abdominal parts

40. Cervical esophagus- boundary
Anterior – trachea , post- pvm lateral – thyroid & carotid .s

41. Thoracic esophagus-Anterior-boundary
41

42. T.Esophagus - posteriorly
Descending A , Azygos V
Thoracic D, Rt post intercostal
Arteries
42

44. T.Esophagus - Laterally
RT - Above T4 abuts lung ,
below azygous is b/n Left -LSA supperiorly
44

45. T.Esophagus-Laterally cont..
LT- Arch of Aorta LT -Upper part of descending Aorta

46. Abdominal Esophagus-boundary
Short 1-3cm , left lobe of liver and left??? crus of diaphragm
46

47. References
• Applied Radiologic anatomy 1st ed, published 1999
• Applied Radiologic anatomy 2nd ed, published 2012
• Fundamentals of diagnostic radiology 4th ed ,published 2012
• Practical fluoroscopy of GI & GU Tracts First ,published 2012
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48. Thank you