Tonsil ultrasound: technical approach and spectrum of pediatric peritonsillar infections

Abstract

Peritonsillar infections are one of the most common deep neck space infections, particularly in adolescents. Inaccurate diagnosis can lead to delay in management and potentially life-threatening complications. Contrast-enhanced computed tomography (CT) scan of the neck traditionally has been used to diagnose suspected peritonsillar abscess. With growing concern over radiation exposure, there has been increasing utilization of ultrasound (US) using intraoral and transcutaneous approaches. We chose the transcutaneous US technique due to its ease of performance in children. The purpose of this article is twofold: a) to describe our technique of performing transcutaneous US of the tonsil showing sonographic appearance of normal tonsil, highlighting pertinent anatomy and unique considerations for this modality in children, and b) to illustrate the sonographic findings in the spectrum of pediatric peritonsillar infections, which includes uncomplicated tonsillitis, peritonsillar cellulitis, small intratonsillar abscess and frank peritonsillar abscess. Parapharyngeal abscess can sometimes be detected.

Sonographic measurement of palatine tonsil volume in children and comparison with actual volume

“…TCU objectively investigates the size, shape, perfusion and appearance of PT to evaluate the diagnosis and prevalence of tonsillar and peritonsillar infections [11,12]. TCU is an alternative and complementary imaging method to computed tomography and magnetic resonance imaging which have some limitations [13].…”

Normative Values for Tonsils in Pediatric Populations Based on Ultrasonography

“…Ultrasonography has been used for the evaluation of tonsillar infections. The infection begins in the peripheral tonsillar crypts and then penetrates the capsule and abscess, into the peritonsillar space . Differentiation between peritonsillar cellulitis and abscesses is important to determine the appropriate treatment.…”

“…The infection extends into the surrounding tissue, resulting in peritonsillar cellulitis or a peritonsillar abscess. Peritonsillar abscesses are characterized by purulent fluid collections . Inaccurate diagnosis can result in delayed management and potentially life‐threatening complications such as extratonsillar extension into the deep neck space or mediastinum, aspiration pneumonia, and sepsis .…”

Ultrasonographic measurement of palatine tonsil size and its correlation with body-mass index and hepatosteatosis in adolescents

“…TCU is a non-invasive, cheap and easily accessible method used to investigate the size, shape, perfusion and appearance of tonsils and to diagnosis and assess distribution of tonsillar and peritonsillar infections (12). Additionally TCU may be compared with CT and MRI with acceptable limits and complements them (13).…”

“…Before surgery, assessment of tonsil anatomy with US is stated to be beneficial to estimate response to tonsillectomy and perioperative complications (8). Studies have shown that TCU is a very effective method for the staging of tonsillitis in children and diagnosis and monitoring of peritonsillar abscess (12,14).…”