In the evaluation of patients with local pathologic dilatation inside the upper airway a pressure-related testing seems important for understanding its pathophysiology and for developing a concept of intra-individually adjusted therapy. Commonly used diagnostic techniques like endoscopy or medical imaging including ultrasound, barium swallow or computer-assisted tomography (CT) have shown limitations either in evaluating a dynamic process or assessing the entirety of cervical structures. This article presents a case report of a professional trumpet player with bilateral pharyngoceles, introducing real-time and three-dimensional (3D) MRI as a helpful tool in the diagnosis of pressure dependent pathologies in the upper airway. With the use of MRI the complete sub- and supraglottic airway can be viewed simultaneously, avoiding the distortion which can occur with endoscopy. Thus, it was possible to evaluate the pharyngoceles pressure-related pathophysiology, from which a successful therapy could be conceived which included modifying the musician's blowing technique. J. Magn. Reson. Imaging 2014;40:55–57. © 2013 Wiley Periodicals, Inc.