Bilateral Peritonsillar Abscess Diagnosed on the Basis of Intraoral Sonography

Lyon, Matthew; Glisson, Paul; Blaivas, Michael

doi:10.7863/jum.2003.22.9.993

Cited by 31 publications

(23 citation statements)

References 6 publications

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“…2 Consequently, aspiration may be falsely negative if the wrong location is aspirated or if the abscess is multiloculated. 3,7 Therefore, blind needle aspiration is also unreliable for the diagnosis of PTA, with a reported false-negative rate of 10-24%. [3][4][5] First reported in the otolaryngology literature, intraoral sonography for the diagnosis of PTA is now described in several reports in the EM literature.…”

Section: Discussionmentioning

confidence: 99%

Intraoral Ultrasound in the Diagnosis and Treatment of Suspected Peritonsillar Abscess in the Emergency Department

Lyon

Blaivas

2005

Acad Emergency Med

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Peritonsillar abscess (PTA) can be a life-threatening disease and may lead to significant complications without drainage. Objectives: To describe the utility of ultrasound (US) in the evaluation of potential PTA and US-guided PTA drainage. Methods: The authors performed a retrospective US quality assurance review of all patients over 18 years of age scanned by emergency physicians for possible PTA. All patients presenting with PTA signs and symptoms including erythema and swelling of the tonsillar pillar and uvular deviation were eligible to be scanned. Patients confirmed to have an abscess on US had US-guided drainage followed by intravenous antibiotics in the emergency department and discharge home on oral antibiotics. Scans were performed by credentialed attending emergency physicians and residents. Researchers recorded patient symptoms, US findings, results of abscess drainage if performed, and any complications of drainage. All US examinations were performed with sheathed endocavity broadband US transducers on minimum depth and maximum resolution settings. Statistical analysis included descriptive statistics. Results: Forty-three patients received intraoral US examinations for suspected PTA. Thirty-five (81%) were diagnosed as having abscess on US. All abscesses were drained with an 18-or 14-gauge needle under US guidance. There were no drainage complications. There was one false positive with a focal area of edema yielding no pus on needle aspiration under direct US visualization. No patient returned unexpectedly after drainage. Conclusions: These data suggest that intraoral US of suspected PTA allows for reliable diagnosis and safe and accurate abscess drainage. Key words: peritonsillar abscess; peritonsillar abscess drainage; peritonsillar ultrasound; emergency ultrasound; intraoral ultrasound; ultrasound-guided procedure. ACADEMIC EMERGENCY MEDICINE 2005; 12:85-88. Peritonsillar abscess (PTA), the most common deep infection of the head and neck, consists of suppuration outside the tonsillar capsule as a consequence of acute tonsillitis.1 Often presenting in the emergency department (ED) setting with the clinical picture of trismus, odynophagia, ''hot potato'' voice, edema and erythema of the superior peritonsillar tissue, and soft palate deviation away from the infected side, 2 PTA can be a life-threatening disease that must be drained in order to resolve.2 Death can occur through rupture into the airway, dissection into the carotid artery, or regional spread of infection leading to sepsis. In most ED settings, diagnosis and subsequent drainage are accomplished using blind needle aspiration of the suspected abscess.2 However, blind needle aspiration is an invasive, painful procedure that has a reported false-negative rate of 10-24%. [3][4][5] In addition, a serious complication of blind needle aspiration of the suspected abscess is laceration of the carotid artery. 2Due to the recent increased availability of ultrasound (US) equipment in the ED, it is now possible for suspected PTA to be imag...

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Section: Discussionmentioning

confidence: 99%

Intraoral Ultrasound in the Diagnosis and Treatment of Suspected Peritonsillar Abscess in the Emergency Department

Lyon

Blaivas

2005

Acad Emergency Med

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“…US also allowed the otorhinolaryngologist to guide needle puncture, avoiding multiple blind punctures in any one patient. This has also been credited to US by Sakagushi et al 1 , Patel et al 4 and Blaivas et al 5 Although transcutaneous US was specific, some cases were not detected. When dealing with patients that have potential risks of serious complications, high false negative rates are unacceptable.…”

Section: Discussionmentioning

confidence: 99%

“…It is typically more common in adolescents and young adults resulting from propagation of tonsillar infections, which lead to cellulitis or peritonsillar abscesss 2 . If treated incorrectly, the abscess may cause severe consequences for patients such as aspiration and pneumonia, as well as deep cervical infection with serious consequences, such as mediastinitis, sepsis and even morte 1,[3][4][5] . Clinically, peritonsillar abscesses and cellulitis have a similar presentation that is almost impossible to differentiate based on the clinical history and the physical examination 3,6,7 .…”

Section: Introductionmentioning

confidence: 99%

Ultra-sonografia intra-oral e transcutânea cervical no diagnóstico diferencial de celulite e abscessos periamigdalianos

Filho

Sakae

Sennes

et al. 2006

Rev. Bras. Otorrinolaringol.

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Ai ms: The objective of the present study was to determine the specificity, sensitivity and accuracy of intraoral and transcutaneous ultrasound (US) in the diagnosis of peritonsillar cellulitis and abscess. Study Design: Clinical-Prospective. Materials and Metods: Thirty nine patients were seen at the otorhinolaryngology emergency department of the University Hospital, of the School of Medicine, University of São Paulo, with a clinical diagnosis of peritonsillar cellulitis or abscess. After initial evaluation, all patients were submitted to intraoral and transcutaneous US. Results: Intraoral US was performed on 35 cases and its sensitivity was of 95.2%, the specificity was of 78.5% and the accuracy was of 86.9%. Transcutaneous US was feasible in all 39 patients and diagnosed peritonsillar abscess in 53.8%. There were 5 false-negatives and 1 falsepositive result, sensitivity was 80%, specificity was 92.8% and accuracy was 84.5%. Conclusions: Intraoral US was quite sensitive in the diagnosis of peritonsillar abscesses when performed by an experienced radiologist. Specificity was higher for transcutaneous US compared to intraoral US. However, when transcutaneous US was performed in patients with trismus, it was able to diagnose all peritonsillar abscesses, since they were large collections which are common in patients with trismus. These exams showed similar accuracy.

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“…6,7 Blind needle aspiration, the typical method of choice to diagnosis a PTA has also been found unreliable with a reported false-negative rate of 10 to 24%. 6,[8][9][10] The reported false negative rates of needle aspirations in patients with proven PTA is mostly quoted in the otolaryngologist literature, and these may be even higher for physicians who are inexperienced or do not regularly perform blind needle aspirations. 10 Furthermore, a blind needle…”

Section: Overview and Clinical Problemmentioning

confidence: 95%

“…This can be very uncomfortable, painful, and potentially dangerous to the patient. [9][10] The close proximity of the internal carotid artery to the tonsils makes clinicians weary of attempting blind needle aspirations especially if the abscess is in the distal part of the tonsil because puncture could have devastating and disabling consequences for the patient.…”

Section: Accepted Manuscriptmentioning

confidence: 99%