High-pressure homogenization is the state of the art to produce high-quality emulsions with droplet sizes in the submicron range. In simultaneous homogenization and mixing (SHM), an additional mixing stream is inserted into a modified homogenization nozzle in order to create synergies between the unit operation homogenization and mixing. In this work, the influence of the mixing stream on cavitation patterns after a cylindrical orifice is investigated. Shadow- graphic images of the cavitation patterns were taken using a high-speed camera and an optically accessible mixing chamber. Results show that adding the mixing stream can contribute to coalescence of cavitation bubbles. Choked cavitation was observed at higher cavitation numbers σ with increasing mixing stream. The influence of the mixing stream became more significant at a higher orifice to outlet ratio, where a hydraulic flip was also observed at higher σ. The decrease of cavitation intensity with increasing back-pressure was found to be identical with conventional high-pressure homogenization. In the future, the results can be taken into account in the SHM process design to improve the efficiency of droplet break-up by preventing cavitation or at least hydraulic flip.