Diagnosis of peritonsillar infections: a prospective study of ultrasound, computerized tomography and clinical diagnosis

Abstract

Peritonsillar infections include cellulitis and abscess (quinsy). Clinical diagnosis is often supplemented by diagnostic drainage (aspiration or incision) in an effort to distinguish abscess from cellulitis. In a prospective study of 14 patients we have shown that clinical impression alone is unreliable (sensitivity 78 per cent, specificity 50 per cent). Computerized tomography (CT) (sensitivity 100 per cent, specificity 75 per cent) and intraoral ultrasound (sensitivity 89 per cent, specificity 100 per cent) are much more reliable. We propose that intraoral ultrasound could play a useful role in the clinical assessment of peritonsillar infections helping to improve accuracy in distinguishing abscesses from cellulitis.

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

“…al. 9 have suggested that needle aspiration is an accurate procedure for this diagnosis, in contrast to Scott et al 7 , that reached 89% sensitivity compared with computerized tomography. Computerized tomography is effective to diagnose deep neck affections, however, it is expensive, subject to complications due to use of contrast and difficult to access in emergency units 1,3 .…”

“…Patients with peritonsillar abscess and cellulitis may present throat pain, fever, dysphagia, trismus, malaise and may progress unfavorably, developing aspiration pneumonia and extension of the infection into deep neck spaces, even leading to death in some cases 1,6,7 . Increases in the number of infections of the peritonsillar space have been observed in children due to the inadequate use of antibiotics 11 .…”

“…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 . Differentiation between these two entities, which are part of the same illness, is essential for successful treatment.…”

“…Differentiation between these two entities, which are part of the same illness, is essential for successful treatment. Peritonsillar abscesses (PAs) may be treated with needle aspiration, drainage of pus or tonsillectomy, while cellulitis (PC) is treated with antibiotics 3,7,8 . The differential diagnosis between cellulitis and peritonsillar abscesses is made by needle aspiration and careful aspiration of the peritonsillar space 8,9 .…”

“…This procedure is painful and risky, there is the possibility of injuring blood vessels such as the internal carotid artery, and it may be difficult in children and patients with significant trismo 1,8,10,11 . An abscess may not be diagnosed in some patients, which results in inadequate treatment 7 . Ultra-sound (US) has been used in the diagnosis of abscesses since 1950; in past 15 years it has become much more frequently used in medical conditions.…”