Abstract: Objective To explore the diagnostic value of high frequency ultrasound combined with oral contrast-enhanced ultrasound (CEUS) and CEUS via elbow vein in pharyngoesophageal diverticulum. Methods A total of 21 cases of pharyngoesophageal diverticulum were examined by high frequency ultrasound combined with two ways of CEUS. The characteristics of conventional ultrasonography and CEUS were summarized. Results Twenty-one cases of pharyngoesophageal diverticulum were diagnosed by high-frequency ultrasound combined with two ways of CEUS. There were three kinds of conventional sonograms of high frequency ultrasound: (1) quasi-circular hypoechoic nodule (3 cases, 5-8 mm in length); (2) quasi-circular or similar to oval-shaped hypoechoic nodules with a patchy hyperechoic area (4 cases, 7-10 mm in length); (3) quasi-circular or similar to oval-shaped inhomogeneous hyperechoic nodules with a patchy hyperechoic area (14 cases, 11-26 mm in length). The typical manifestations of oral CEUS: when swallowing, the strong echo formed by contrast medium suspension quickly passed through the esophageal cavity and entered the lesion from the esophageal cavity with narrow band strong echo. The strong echo of swallowing interval disappeared partly and remained in the lesion. When swallowing again, the strong echo entered the lesion repeatedly. The typical manifestations of CEUS via elbow vein: after bolus injection of contrast-enhanced ultrasound agent, the early lesions of arteries and esophageal wall were enhanced synchronously, and banded enhancement areas could be seen between them. Conclusions The conventional sonographic features of pharyngoesophageal diverticulum vary with the size and contents of the diverticulum. Both oral CEUS and elbow vein CEUS have typical sonographic features. High-frequency ultrasound combined with two ways of CEUS can effectively improve the accuracy of ultrasound diagnosis for pharyngoesophageal diverticulum.