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Lateral pharyngeal pouches are transient outpouchings of the proximal anterolateral hypopharyngeal wall, whereas lateral pharyngeal diverticula are persistent sacs through the same area of weakness in the pharyngeal wall [37]. Lateral pharyngeal pouches protrude through an area bounded superiorly by the hyoid bone, anteriorly by the thyrohyoid muscle, inferiorly by the ala of the thyroid cartilage, and posteriorly by the superior cornu of the thyroid cartilage [37] (Figure 6.17A).

Lateral pharyngeal pouches appear on barium studies as smooth‐surfaced hemispheric outpouchings of the upper anterolateral hypopharyngeal wall just below the level of the hyoid bone (Figure 6.17B,C). Barium enters the pouches and then spills into the ipsilateral piriform sinus, either late in the swallow or just after swallowing. Overflow aspiration is uncommon. In contrast, barium is retained in lateral pharyngeal diverticula long after the swallow has been completed (Figure 6.18). Lateral pharyngeal pouches are usually bilateral, whereas lateral pharyngeal diverticula are usually unilateral (Figure 6.18).

Lateral pharyngeal pouches are common, and their incidence increases with age. Lateral pharyngeal diverticula are much less common, usually occurring in patients with elevated intrapharyngeal pressures. Most of these patients are asymptomatic, but about 5% with lateral pharyngeal pouches complain of a feeling of incomplete swallowing [38, 39]. Patients with lateral pharyngeal diverticula may also complain of dysphagia, choking, regurgitation of undigested food, or a painless neck mass.