Normal barium swallow (lateral view)

Case contributed by Matt A. Morgan
Diagnosis not applicable


Short term dysphagia. No other symptoms. Normal study.

Patient Data

Age: 35 years
Gender: Female

Normal barium swallow: the bolus moves through three main phases

  • oral phase
  • pharyngeal phase
  • esophageal phase

At the end of the initial swallow, the pharynx is coated in high-density barium, allowing a double contrast view.

Annotated image

Annotated images from the normal barium swallow.

Oral phase: base of tongue (red arrow) apposed to the soft palate (dark blue bracket). There is no premature spillage into the pharynx. The hard palate is demarcated by the purple bracket.

Oral phase, normal anatomy: hyoid bone (blue arrow), laryngeal vestibule/aditus (yellow bracket), air in the laryngeal ventricle between the true and false vocal cords (green arrow), proximal trachea (red bracket).

Pharyngeal phase: Normal epiglottic tilt (pink arrow), normal redundant pharyngeal mucosa (orange arrow). Soft palate opposed to nasopharynx prevents nasopharyngeal reflux. Barium proceeds down the cervical esophagus.

After initial barium swallow: red arrows pointing to the base of the tongue (above) and the outline of the epiglottis (below). Valleculae (V). Pyriform sinus (P).

Division of the mesopharynx (above) and hypopharynx (below).

Red line parallels the faint palatoglossal fold. Yellow line parallels the faint stylopharyngeus muscle. The pink arrow points to the aryepiglottic folds.

Case Discussion

Swallowing is a complex act involving both voluntary and involuntary neural circuits and the coordination of multiple small muscles in the neck.

Disruption of a part of this circuit may lead to compensation from other structures. The patient may be unaware of the compensation, but barium swallow will often reveal it. This may eventually become decompensated, prompting symptoms (such as aspiration), and barium swallow is again useful for diagnosis.

It is useful to get a feel for the normal structures in a barium swallow in order to help determine what may be causing a patient's compensated or decompensated swallowing.

Always remember to image the entirety of the esophagus when performing an assessment of swallowing, as pharyngeal symptoms may have an esophageal origin, and since there is an association between pharyngeal and esophageal pathologic processes (e.g. GERD/GERD).

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