Radiological imaging of the pharyngeal diseases.

Dr/ ABD ALLAH NAZEER. MD.

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.

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

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.

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.

Severe acute pharyngitis.

Retropharyngeal Abscess.

CT of retropharyngeal abscess

Retropharyngeal Abscess (CT, )

Retropharyngeal Abscess.

Lateropharyngeal abscess.

Acute bacterial tonsillitis.

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

Tonsillar abscess (CT).

Epiglotitis (Radiography, )

Periodontal abscess (CT).

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.

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%).

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.

Nodular fasciitis.

Nodular fasciitis.

Retropharyngeal lipoma.

Retropharyngeal lipoma.

Neural fibrolipoma in pharyngeal mucosal space.

Hemangioma of the pharynx.

Pleomorphic adenoma of the hypopharynx.

Pleomorphic adenoma of the hypopharynx.

Pleomorphic adenoma.

Pleomorphic adenoma in the parapharyngeal mass.

Hypopharyngeal duct cyst.

Paraganglioma of the hypopharynx.

Vagal schwannoma. Cystic choristoma.

Glomus vagale. Neurofibroma.

Carotid body tumor. True internal carotid artery aneurysm

Internal carotid pseudoaneurysm. Meningioma.

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

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 alcoholabuse. In some regions, particularly the Indian subcontinent,oral cancer is among the most frequent malignancies, largelydue 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.

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 .

Parapharyngeal squamous carcinoma.

Squamous cell carcinoma.

Hypopharyngeal squamous cell carcinoma.

Post-cricoid squamous carcinoma.

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

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

Metastatic adenopathy from a tonsilar carcinoma.

Adenocarcinoma of left hypopharynx with lymph nodes metastasis.

Tonsillar primary adenocarcinoma with lymph node metastasis

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:

Non-Hodgkin’s lymphoma.

Diffuse large cell lymphoma.Mixed cellularity Hodgkin lymphoma in

HIV positive patient.

Follicular lymphoma. B-Cell Lymphoma.

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

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.

Thank You.