Quinsy: A bilateral presentation

Kristensen, Simon; Juul, Aksel; Nielsen, F

doi:10.1017/s0022215100096948

Cited by 17 publications

(6 citation statements)

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“…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. [8][9][10] The reported sensitivity for intraoral sonography varies from 90% to 100%, depending on the training of the sonographer as well as the field of training.…”

Section: Discussionmentioning

confidence: 99%

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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%

“…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.…”

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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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“…inferiorly, away from the bony confines of the skull base, mandible, and hyoid bone. Pus may burst medially through the buccopharyngeal fascia causing aspiration pneumonia (Kristensen et al, 1985). Pus may descend through the retropharyngeal space to the superior mediastinum where the buccopharyngeal fascia (anteriorly) merges with the alar fascia (posteriorly).…”

Section: Discussionmentioning

confidence: 99%

“…Spread through fascial planes Extrinsic airway compression/aspiration pneumonia (Kristensen et al, 1985) Necrotising fasciitis (Yii et al, 1996) Carotid artery rupture. The internal carotid artery is the source in over half of the cases (Sallinger and Pearlman, 1933) Necrotising mediastinitis (Collin and Beasley, 2006) Internal jugular vein thrombosis from direct compression (Alexander et al, 1968) Meningitis resulting from a fistula between the prevertebral space and the dura through an intervertebral foramen (Gidley et al, 1997) Lemierre syndrome results if septic emboli are thrown off from a thrombosed internal jugular vein (Weesner and Cisek, 1993) Cranial nerve IX-XII palsy (Alsoub and Chacko, 1995) posteriorly allowing visualization of the carotid arteries, before the blunt dissection is carried out.…”

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confidence: 99%

Parapharyngeal abscess: A life‐threatening complication of quinsy

et al. 2007

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“…This is an invasive, painful procedure, which has reported false-negative rates of 10% to 24%. 4,7,8 An additional serious complication to blind needle aspiration of the suspected abscess is laceration of the carotid artery. 6 Buckley et al 4 concluded that intraoral sonography could be used to confirm or exclude the diagnosis of a peritonsillar abscess reliably.…”

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Bilateral Peritonsillar Abscess Diagnosed on the Basis of Intraoral Sonography

Lyon

Glisson

Blaivas

2003

J of Ultrasound Medicine

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, 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

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Quinsy: A bilateral presentation

Abstract: Bilateral peritonsillar abscesses are rare and often not diagnosed until tonsillectomy. As the condition may create diagnostic problems and serious complications, a case history is presented. The importance of rapid otorhinolaryngological examination and treatment is stressed.

Cited by 17 publications

References 8 publications

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

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

Parapharyngeal abscess: A life‐threatening complication of quinsy

Bilateral Peritonsillar Abscess Diagnosed on the Basis of Intraoral Sonography

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