, DO, Michael Blaivas, MD, RDMS peritonsillar abscess consists of suppuration outside the tonsillar capsule as a consequence of acute tonsillitis.1,2 Even though acute tonsillitis is a bilateral process, a peritonsillar abscess rarely occurs bilaterally.2 However, when it occurs bilaterally, the key clinical features of the peritonsillar abscess are absent. Specifically, uvular and palatal deviation away from the abscess will not be present.3 This can make the clinical diagnosis of a bilateral peritonsillar abscess difficult, leading to complications that include extension to the retropharyngeal space, rupture leading to aspiration, mediastinitis, erosion into the carotid artery, and sepsis. In the following case, intraoral sonography was used to show a bilateral peritonsillar abscess and to aid in its drainage. To our knowledge, this is the first case report describing a bilateral peritonsillar abscess shown by intraoral sonography.Received March 24, 2003, Case ReportA 24-year-old man was transferred to the emergency department from an outlying military facility that was without specialty care. The patient had a 4-day history of fever, sore throat, and difficulty swallowing his own secretions. On physical examination, the patient appeared moderately ill but not toxic or anxious. He had a temperature of 38.6°C and a "hot potato" voice but no signs of upper airway obstruction or trismus. Physical examination revealed bilateral peritonsillar edema, no deviation of the uvula, and bilateral soft palate erythema with exudates.No laboratory tests were repeated in the emergency department. The patient had a soft tissue lateral neck radiograph from the military facility that clearly showed a soft tissue mass above the epiglottis.The otolaryngology service was consulted to evaluate the patient in the emergency department. The working