The role of computed tomography in the management of peritonsillar abscess

Abstract

Twenty-four patients who fulfilled the clinical criteria for peritonsillar abscess (PTA) were randomized into two groups over a 6-month period. Group A (n = 13) underwent CT with contrast, whereas group B (n = 11) was managed without radiologic investigation. In group A, CT with contrast enabled differentiation of PTA from peritonsillar cellulitis in all 13 cases (100%) and demonstrated abscesses in 11 patients (85%), thereby allowing drainage at first attempt. Two patients with peritonsillar cellulitis were successfully managed with antibiotics only. In group B, all patients underwent needle aspiration. In seven patients (64%), pus was found after needle aspiration at first attempt and in one patient after needle aspirations at two locations. In three patients (27%), no pus was found after needle aspirations at three different locations. We conclude that CT enhances diagnostic accuracy, obviating unnecessary drainage procedures, and reduces patient morbidity.

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

“…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.…”

“…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 .…”

Pediatric Tonsillar Malignancies: Misleading Presentations

“…Recent studies have cautioned clinicians using CT imaging in children due to potential risk of radiation induced malignancy [6]. Alternatively, CT imaging enhances diagnostic accuracy in distinguishing abscesses from cellulitis [7] and reduces morbidity by eliminating unnecessary drainage of peritonsillar cellulitis [8]. In all three cases, subtle findings on CT imaging with contrast were inconsistent with a diagnosis of infection and prompted further evaluation for tonsillar malignancy.…”

Specified data for tonsil surgery in Germany

“…It cannot be excluded that patients had undergone an elective TE after a certain period of time (then coded as 5-281.0) after an initial incisional drainage had been performed (coded as 5-280.0). The database also does not provide specific data for needle aspiration or antibiotic therapy alone for PTA [74], [75], [76], [77]. …”