Pharyngocele: An Unusual Cause of Oropharyngeal Dysphagia

Introduction: Pharyngocele is a pharyngeal diverticula formed by henial protrusion of the mucosa, through a weakness of the hypopharynx. Because of its rare occurrence, diagnosis may be challenging.

Objective: The aim of this study is to present a case of oropharyngeal dysphagia because of pharyngoceles and emphasize clinical and radiological findings that contributed to the diagnosis.

Case report: An otherwise healthy 28-year-old male patient referred a 10-year history of occasional regurgitation of undigested food. The episodes occurred right after eating, especially with solid boluses, when he leaned forward or contracted the pharyngeal muscles. He also presented some episodes of aspiration, evidenced by cough while eating, but no history of pneumonia. Initial nasofiberscopy showed slightly enlarged lingual tonsils hampering the visualization of the vallecula, but it was otherwise unremarkable. There was no evident pooling, penetration, or aspiration of saliva. Initial computed tomography (CT) scan of the neck suggested the presence of bilateral mixed laryngoceles, but after barium-enhanced esophagogram revealed bilateral pharyngoceles, review of the CT scans corrected the diagnosis for pharyngoceles that extended lateral to the vallecula in each side. Further endoscopic examination with a rigid laryngeal telescope with tongue protrusion could identify the pharyngoceles extending under the pharyngoepiglottic fold in each side, contouring the hyoid bone.

Conclusion: Pharyngocele is a rare condition that may lead to dysphagia and regurgitation of food boluses. Initial physical examination and nasofiberscopy may be unremarkable. Barium-contrasted esophagogram, CT scan of the neck, and rigid laryngotelescopy may help in the diagnosis.