Peritonsillar abscess CT scan

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Prince Tano Djan, BSc, MBChB [2]

Overview

CT scan is helpful in defining the characteristics of the abscess as well as to classify it. It also helps in guiding possible complications. Coronal contrast-enhanced CT scan of the neck may identify the peritonsillar abscess[1] however, the use of CT scan is associated with a clinically significant delay in time to an otolaryngology consultation, time to admission, and time to bedside procedure.[2] CT scan may show diffuse hypodense lesion with rim enhancement in the peritonsillar space.[3]

CT scan

  • Imaging is helpful in differentiating peritonsillar abscess from peritonsillar cellulitis as well as a guide during abscess drainage.[4][1][5][6][7]
  • CT scan is helpful in defining the characteristics of the abscess as well as to classify it.
  • It also helps in guiding possible complications. For example, patients with inferior cap-type abscess are at highest incidence of extraperitonsillar spread than the other categories of peritonsillar abscess.[8]
  • Coronal contrast-enhanced CT scan of the neck may identify the peritonsillar abscess[1] however, the use of CT scan is associated with a clinically significant delay in time to an otolaryngology consultation, time to admission, and time to bedside procedure.[2]
  • CT scan may show diffuse hypodense lesion with rim enhancement in the peritonsillar space.[3]



CT scan showing and right-sided peritonsillar abscess


The image above shows a CT scan of right-sided peritonsillar abscess.[9] Courtesy James Heilman, MD

References

  1. 1.0 1.1 1.2 Bandarkar AN, Adeyiga AO, Fordham MT, Preciado D, Reilly BK (2016). "Tonsil ultrasound: technical approach and spectrum of pediatric peritonsillar infections". Pediatr Radiol. 46 (7): 1059–67. doi:10.1007/s00247-015-3505-7. PMID 26637999.
  2. 2.0 2.1 Grant MC, Guarisco JL (2016). "Association Between Computed Tomographic Scan and Timing and Treatment of Peritonsillar Abscess in Children". JAMA Otolaryngol Head Neck Surg. 142 (11): 1051–1055. doi:10.1001/jamaoto.2016.2035. PMID 27533126.
  3. 3.0 3.1 Chen Y, Yang Q, Wang T, Li J, Ye J, Liu X; et al. (2014). "[Application of enhanced CT in the differential diagnosis of peritonsillar abscess and intratonsillar abscess]". Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 49 (2): 131–5. PMID 24742512.
  4. Costantino TG, Satz WA, Dehnkamp W, Goett H (2012). "Randomized trial comparing intraoral ultrasound to landmark-based needle aspiration in patients with suspected peritonsillar abscess". Acad Emerg Med. 19 (6): 626–31. doi:10.1111/j.1553-2712.2012.01380.x. PMID 22687177.
  5. Buckley AR, Moss EH, Blokmanis A (1994). "Diagnosis of peritonsillar abscess: value of intraoral sonography". AJR Am J Roentgenol. 162 (4): 961–4. doi:10.2214/ajr.162.4.8141026. PMID 8141026.
  6. Strong EB, Woodward PJ, Johnson LP (1995). "Intraoral ultrasound evaluation of peritonsillar abscess". Laryngoscope. 105 (8 Pt 1): 779–82. doi:10.1288/00005537-199508000-00002. PMID 7630286.
  7. Blaivas M, Theodoro D, Duggal S (2003). "Ultrasound-guided drainage of peritonsillar abscess by the emergency physician". Am J Emerg Med. 21 (2): 155–8. doi:10.1053/ajem.2003.50029. PMID 12671820.
  8. Kawabata M, Umakoshi M, Makise T, Miyashita K, Harada M, Nagano H; et al. (2016). "Clinical classification of peritonsillar abscess based on CT and indications for immediate abscess tonsillectomy". Auris Nasus Larynx. 43 (2): 182–6. doi:10.1016/j.anl.2015.09.014. PMID 26527518.
  9. {{https://commons.wikimedia.org/wiki/File:PeritonsilarAbs.png

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