Cricopharyngeus Muscle

If your radiology report mentions the “cricopharyngeus muscle,” it’s referring to a ring of muscle at the top of the esophagus. This muscle acts like a valve that opens during a swallow to let food and liquid pass from the throat into the esophagus. On imaging, especially swallowing X-rays, it can appear as a normal indentation or as a thicker “bar.” Most findings are benign, but sometimes they explain symptoms like trouble swallowing. This article explains what radiologists look for, what common phrases mean, and when follow-up might be helpful.

Where the cricopharyngeus is located and what it does

The cricopharyngeus sits behind the voice box at the level of the lower neck (roughly C5–C6). It forms the main part of the upper esophageal sphincter. At rest, it stays closed to keep air out of the esophagus and to prevent backflow from the esophagus into the throat. During a swallow, it relaxes and opens briefly.

Why this muscle shows up on imaging

Imaging is often ordered to evaluate symptoms such as difficulty swallowing, food “sticking” in the throat, coughing during meals, hoarseness, or repeated pneumonias from aspiration. The cricopharyngeus is a key checkpoint in swallowing, so radiologists evaluate it carefully.

Common imaging tests that show this muscle include:

Modified barium swallow (videofluoroscopic swallow study)

This X-ray test is done with a speech-language pathologist. You swallow small amounts of barium mixed with food or liquid while the camera records in real time. The study shows how well the cricopharyngeus relaxes and opens, whether material briefly pools above it, and if any barium goes the wrong way toward the airway.

Barium esophagram (standard swallowing X-ray)

This series of X-rays tracks barium through the esophagus. The cricopharyngeus typically appears as a short, smooth indentation on the back wall of the upper esophagus. Radiologists assess its thickness, smoothness, and how it changes as you swallow.

CT or MRI of the neck

These cross-sectional scans are not first-line for swallowing mechanics, but they can show thickening, scarring, or a pouch just above the cricopharyngeus. CT is helpful if your doctor is also concerned about inflammation, prior surgery, radiation changes, or rare masses.

“Cricopharyngeal bar” on X-ray: what it means

A cricopharyngeal bar is a short, shelf-like impression seen along the back of the upper esophagus on barium studies. It represents a tight or thickened cricopharyngeus muscle. Key points:

• It can be a normal variant and cause no symptoms.

• It may reflect incomplete relaxation of the muscle during the swallow.

• It is sometimes linked with reflux, scarring after radiation, or age-related changes.

• When significant, it can contribute to a sensation of food sticking at the lower throat and sometimes to cough or choking.

Radiologists comment on how prominent the bar is, whether it blocks barium, and whether there is pooling of contrast just above the muscle.

Zenker diverticulum: the pouch above the muscle

If pressure builds repeatedly above a tight cricopharyngeus, a pouch called a Zenker diverticulum can develop. This outpouching occurs in a weak spot just above the muscle. On barium swallow, it fills with contrast and can trap food, leading to bad breath, regurgitation of undigested food, chronic cough, or aspiration. Radiology reports will describe its size, neck (opening), and whether material lingers in it after a swallow. Treatment decisions consider symptoms, size, and risk of aspiration.

What radiologists look for on a swallow study

When your report mentions the cricopharyngeus, it often includes observations such as:

• Timing and opening: Does the muscle relax at the right moment and open wide enough?

• Residue: Is there leftover barium just above the muscle after a swallow?

• Penetration or aspiration: Does material enter the voice box or lungs?

• Compensations that help: Posture changes (chin tuck, head turn) or thicker liquids can sometimes improve passage; the report may note what worked during the test.

These details guide your doctor and speech-language pathologist in tailoring therapy.

Normal vs. abnormal appearances

Normal: A faint, smooth, brief indentation at the posterior upper esophagus that disappears as the bolus passes. No pooling, no airway invasion, and normal passage of both thin and thick liquids.

Common abnormal patterns:

• Prominent cricopharyngeal bar: A thicker impression that partially narrows the passage; may correlate with a “sticking” sensation.

• Incomplete relaxation (achalasia of the UES): The muscle does not open fully, leading to stalling of material above it.

• Zenker diverticulum: A contrast-filled pouch above the muscle that retains material.

• Post-treatment change: After neck radiation or surgery, scarring can stiffen the muscle, reducing opening. Radiology reports will often use words like “restricted UES opening.”

Symptoms that match imaging findings

• Throat-level dysphagia: Food catching at the lower throat rather than behind the breastbone.

• Regurgitation of undigested food minutes to hours later: Suggestive of a pouch.

• Choking, wet voice, or coughing during meals: May indicate penetration or aspiration seen on video.

• Weight loss or recurrent pneumonias: Red flags that push clinicians to act on imaging results.

How imaging guides treatment

Imaging does not treat the problem, but it pinpoints the level and pattern of dysfunction so the right therapy can be chosen:

• Swallow therapy: A speech-language pathologist may teach maneuvers, posture changes, and bolus modifications to improve opening at the cricopharyngeus and protect the airway.

• Diet adjustments: Temporary changes in liquid thickness or bite size based on what worked during the study.

• Dilation or injection: For a tight cricopharyngeal bar, procedures can gently stretch the area or relax it with botulinum toxin.

• Surgery (myotomy) or endoscopic stapling/division: Considered for significant, persistent symptoms or a large Zenker diverticulum. Imaging helps size and localize the problem before intervention.

Your care team will match what you feel with what the images show and choose the lowest-risk option that addresses your symptoms.

CT and MRI details in plain language

On CT, the cricopharyngeus may appear as a short ring of muscle behind the voice box. Thickening alone is not always abnormal and must be interpreted with your history and swallow study. CT may also show air- or fluid-filled pouches (diverticula), inflammation, or changes after radiation.

On MRI, the region is seen with excellent soft-tissue detail, but MRI is used less often for swallowing mechanics. It can be helpful if other neck structures need evaluation at the same time.

Questions you might see on a report—decoded

• “Prominent cricopharyngeal impression/bar”: The muscle looks thicker; may or may not be symptomatic.

• “Reduced UES opening”: The valve is not opening wide enough during swallows.

• “Residue in the pyriform sinuses”: Material collects in small side pockets just above the cricopharyngeus, often when the opening is restricted.

• “Penetration/aspiration observed”: Some material reached the voice box or entered the airway; your team will address strategies to reduce risk.

• “Zenker diverticulum identified”: A pouch above the muscle is present; size and neck are described.

When to ask for next steps

Talk with your doctor if you have persistent trouble swallowing, coughing with meals, unexplained weight loss, or frequent chest infections. Bring your imaging report to the visit. Ask whether a speech-language pathology evaluation, reflux management, trial of therapy, or a visit with an ENT or GI specialist is appropriate.

Bottom line: Most cricopharyngeus findings on imaging are manageable. The report gives your care team a map of the exact problem so they can tailor therapy or, if needed, a simple procedure.

Conclusion
The cricopharyngeus muscle is the gateway from throat to esophagus. On radiology exams, it can look completely normal, mildly prominent, or clearly restrictive. Your report’s wording—combined with your symptoms—guides the plan, from swallow therapy to occasional procedures. Understanding what the terms mean helps you make informed decisions and work with your team toward safer, more comfortable swallowing.

References

https://radiopaedia.org/articles/cricopharyngeal-bar?lang=us

https://www.radiologyinfo.org/en/info/modbariumswallow

https://pubmed.ncbi.nlm.nih.gov/32650657/