This document summarizes radiological imaging techniques for diagnosing diseases of the pharynx. It discusses anatomy of the hypopharynx and oropharynx. Common imaging modalities include x-rays, CT scans, MRI, and PET CT scans. The document outlines congenital anomalies, inflammatory diseases like pharyngitis and tonsillitis, infections like retropharyngeal and peritonsillar abscesses. It also discusses benign and malignant tumors that can occur in the pharynx such as papillomas, hemangiomas, pleomorphic adenomas, squamous cell carcinomas, and lymphomas. Radiological images are provided to illustrate various pathologies.

1. Radiological imaging of
the pharyngeal diseases.
Dr/ ABD ALLAH NAZEER. MD.

2. Pharynx (oro and hypopharynx).
The hypopharynx is in continuity with the oropharynx and
extends from the level of the hyoid bone to the opening of
the esophagus. It is composed of the inferior aspect of the
middle constrictor and the inferior pharyngeal constrictor
muscles. The hypopharynx sits behind the larynx, and its
lateral-most walls, the pyriform sinuses, are nestled
medial to the thyroid lamina. Immediately posterior to the
hypopharynx is the potential retropharyngeal space; the
prevertebral fascia is posterior to that. Patients with
tumors of the hypopharynx present with progressive
difficulty and pain on swallowing, first to solids and then
to liquids; they often report experiencing referred otalgia.
Anatomy.

4. Imaging studies:
A. X-rays.
B. CT scans.
C. MRI.
D. PET CT Scan.

5. Congenital anomalies of oropharynx.
Both pharyngeal atresia (Morris and Reay, 1971) and congenital large
pharynx (Calnan, 1971) have been reported. Patients with congenital
large pharynx and velopharyngeal insufficiency are not helped with
palatal push-back surgery; instead, a posterior pharyngeal flap is
needed. The presence of a subglossopalatal membrane has been
reported in one girl, who developed dyspnea and dysphagia after birth
(Nakajima et al, 1979). A thick, fan-shaped fibrous membrane existed
from the subglossal region to the junction of the cleft of the soft palate
and the hard palate. The literature records a persistent
buccopharyngeal membrane (Chandra et al, 1974) and pharyngeal
membrane (Hoffman, 1979) from the anterior pillar to the base of the
tongue, interfering with speech, posterior pillar mucosal webbing, and
palatal pharyngeal muscle displacement (Warren et al, 1978).
Newcomb (1897) reported 42 cases that included absence of pillars and
tonsils and lymphoid tissue abnormalities.

9. Pharyngitis is a type of inflammation, most commonly caused by
an upper respiratory tract infection. It may be classified as acute
or chronic. An acute pharyngitis may be catarrhal, purulent or
ulcerative, depending on the virulence of the causative agent and
the immune capacity of the affected individual. Chronic
pharyngitis is the most common otolaringologic disease and may
be catarrhal, hypertrophic or atrophic.
Most acute cases are caused by viral infections (40–80%), with the
remainder caused by bacterial infections, fungal infections, or
irritants such as pollutants or chemical substances.
Tonsillitis is inflammation of the tonsils most commonly caused by
viral or bacterial infection. Symptoms may include sore throat and
fever. When caused by a bacterium belonging to the group A
streptococcus, it is typically referred to as strep throat.
Inflammatory diseases.

10. Severe acute pharyngitis.

11. Retropharyngeal Abscess.

12. CT of retropharyngeal abscess

13. Retropharyngeal Abscess (CT, )

14. Retropharyngeal Abscess.

15. Lateropharyngeal abscess.

16. Acute bacterial tonsillitis.

17. Bilateral peritonsillar abscesses (PTA).CT of peritonsillar abscess (late stage).

18. Tonsillar abscess (CT).

19. Epiglotitis (Radiography, )

20. Periodontal abscess (CT).

21. Benign tumour of the hypo and oropharynx.
Usually uncommon and present as smooth,
well defined, pedunculated and mobile mass.
Papilloma.
Hemangioma.
Pleomorphic adenoma.
Mucous cyst.
Lipoma.
Fibroma.
Leiomyoma.
Vascular tumors.

22. Malignant tumour of the hypo and oropharynx.
Histological classification:
Squamous cell carcinoma: may be,
well/moderately/ poorly differentiated.
Lymphoepithelioma.
Adenocarcinoma.
Lymphoma, both Hodgkin and non-Hodgkins.
Carcinoma of the hypopharynx occur in order of
frequency:
Pyriform sinus(60%).
Post-cricoid region(30%).
Posterior pharyngeal wall(10%).

25. Nodular fasciitis caused a benign tumor which is
composed of fibrous tissue. The most commonly
affected site is the upper extremity, which accounts for
half of all cases. Ten to 20% of the lesions occur in the
head and neck area, most of which are subcutaneous.
We report a case of nodular fasciitis, which presented
as an unusually large submucosal tumor of the pharynx.
The tumor was extended from the retropharyngeal to
the parapharyngeal space, and it was measured 8 x 4 x
3 cm in size. Since nodular fasciitis is known for the
spontaneous regression, the tumor was transorally
debulked by the use of YAG laser.
Giant tumor formed by nodular fasciitis of the pharynx.

26. Nodular fasciitis.

27. Nodular fasciitis.

28. Retropharyngeal lipoma.

29. Retropharyngeal lipoma.

30. Neural fibrolipoma in pharyngeal mucosal space.

31. Hemangioma of the pharynx.

32. Pleomorphic adenoma of the hypopharynx.

33. Pleomorphic adenoma of the hypopharynx.

34. Pleomorphic adenoma.

35. Pleomorphic adenoma in the parapharyngeal mass.

37. Hypopharyngeal duct cyst.

38. Paraganglioma of the hypopharynx.

39. Vagal schwannoma. Cystic choristoma.

40. Glomus vagale.Neurofibroma.

41. Carotid body tumor. True internal carotid artery aneurysm

42. Internal carotid pseudoaneurysm. Meningioma.

43. Multiplanar mutisequential MRI of a 24 year-old patient known for neurofibromatosis
type 1. Note the large left sided suprahyoid neurofibroma (arrowheads).

44. Malignant tumours of the hypo and oropharynx.
Squamous cell carcinomas amount to more than 90% of
malignant tumours of the hypo and oropharynx. As in other
parts of the upper aerodigestive tract, there is a strong and
synergistic association with tobacco smoking and alcohol
abuse. In some regions, particularly the Indian subcontinent,
oral cancer is among the most frequent malignancies, largely
due to tobacco chewing.
The WHO Working Group has made an attempt to unify the
terminology used to define the histological features of
precursor lesions throughout the head and neck region.
Although there has been considerable progress in the
understanding of the genetic and molecular events underlying
the progression of precancerous lesions to invasive carcinomas,
this has yet to be translated into novel therapeutic strategies.

45. Oropharyngeal squamous cell carcinomas (OSCC) begins
in the oropharynx , the middle part of the throat that
includes the soft palate , the base of the tongue , and
the tonsils . Squamous cell cancers of the tonsils are
more strongly associated with human papillomavirus
infection than are cancers of other regions of the head
and neck.
The hypopharynx includes the pyriform sinuses, the
posterior pharyngeal wall, and the postcricoid area.
Tumors of the hypopharynx frequently have an
advanced stage at diagnosis, and have the most
adverse prognoses of pharyngeal tumors. They tend
to metastasize early due to the extensive lymphatic
network around the larynx .

46. Parapharyngeal squamous carcinoma.

47. Squamous cell carcinoma.

48. Hypopharyngeal squamous cell carcinoma.

49. Post-cricoid squamous carcinoma.

52. Right tonsil cancer with spread through constrictor
muscle directly into parapharyngeal fat.

53. Two cases of left tonsillar carcinoma, which causes effacement
of the fat of the retropharyngeal space on the left.

56. Metastatic adenopathy from a tonsilar carcinoma.

57. Adenocarcinoma of left hypopharynx with lymph nodes metastasis.

58. Tonsillar primary adenocarcinoma with lymph node metastasis

59. The initial manifestation of certain lymphoid disorders
may be a tumor of the nasopharynx or pharynx. At
the present time there seems to be no accurate way
of predicting the subsequent behavior of the varying
types of lymphoid tumors which appear in this area.
The basis of this report is an analysis of the clinical
and pathological data whose presenting symptoms
was discovered a primary lymphomatous neoplasm
of the pharynx, with no simultaneous evidence of
systemic involvement or of disease elsewhere in the
body.
LYMPHOMAS OF THE PHARYNX:

60. Non-Hodgkin’s lymphoma.

61. Diffuse large cell lymphoma.
Mixed cellularity Hodgkin lymphoma in
HIV positive patient.

62. Follicular lymphoma. B-Cell Lymphoma.

63. Unilateral mass was found in the tonsil, associated with cervical
lymphadenopathy, in the HL group, nodular sclerosis subtype.

64. A case of tonsillar B-cell lymphoma with extensive local spread
(arrow) as seen on MIP (A) CT (B) and fused PET/CT (C) Images.

65. Thank You.