Peritonsillar abscess differential diagnosis: Difference between revisions
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[[Streptococcus pyogenes|pyogenes]].<ref name="pmid15573356" /><ref name="pmid18039418" /><ref name="pmid1875138" /><ref name="pmid12092281" /> | [[Streptococcus pyogenes|pyogenes]].<ref name="pmid15573356" /><ref name="pmid18039418" /><ref name="pmid1875138" /><ref name="pmid12092281" /> | ||
|[[Contralateral]] deflection of the uvula, | |[[Contralateral]] deflection of the [[uvula]], | ||
the [[tonsil]] is displaced [[inferiorly]] and [[medially]], tender [[submandibular]] and [[anterior]] [[cervical lymph nodes|cervical lymph nodes,]] [[Tonsillar abscess|tonsillar]] [[hypertrophy]] with likely peritonsillar [[edema]]. | the [[tonsil]] is displaced [[inferiorly]] and [[medially]], tender [[submandibular]] and [[anterior]] [[cervical lymph nodes|cervical lymph nodes,]] [[Tonsillar abscess|tonsillar]] [[hypertrophy]] with likely peritonsillar [[edema]]. | ||
|The highest occurrence is in adults between 20 to 40 years of age.<ref name="pmid18246890" /> | |The highest occurrence is in adults between 20 to 40 years of age.<ref name="pmid18246890" /> | ||
| Line 36: | Line 36: | ||
|Has [[cough]] and [[stridor]] but no [[drooling]]. Others are [[Hoarseness]], [[Difficulty breathing]], symptoms of the [[common cold]], [[Runny nose]], [[Fever]] | |Has [[cough]] and [[stridor]] but no [[drooling]]. Others are [[Hoarseness]], [[Difficulty breathing]], symptoms of the [[common cold]], [[Runny nose]], [[Fever]] | ||
|[[Parainfluenza virus]] | |[[Parainfluenza virus]] | ||
|Suprasternal and [[intercostal]] [[Indrawing|indrawing,]]<ref name="pmid19445760" /> Inspiratory [[stridor]]<ref name="Cherry2008" />, expiratory [[wheezing]],<ref name="Cherry2008" /> [[Sternal]] wall retractions<ref name="pmid194457602" /> | |[[Suprasternal notch|Suprasternal]] and [[intercostal]] [[Indrawing|indrawing,]]<ref name="pmid19445760" /> Inspiratory [[stridor]]<ref name="Cherry2008" />, expiratory [[wheezing]],<ref name="Cherry2008" /> [[Sternal]] wall retractions<ref name="pmid194457602" /> | ||
|Mainly 6 months and 3 years old | |Mainly 6 months and 3 years old | ||
rarely, adolescents and adults<ref name="pmid8769531" /> | rarely, adolescents and adults<ref name="pmid8769531" /> | ||
| Line 43: | Line 43: | ||
|- | |- | ||
|[[Epiglottitis]] | |[[Epiglottitis]] | ||
| | |[[Stridor]] and [[drooling]] [[Difficulty breathing|but no cough. Other symptoms include difficulty breathing]], [[Difficulty swallowing|fever, chills, difficulty swallowing]], [[hoarseness]] of [[voice]] | ||
|[[Hemolysis|H. influenza type b,]] | |[[Hemolysis|H. influenza type b,]] | ||
[[Hemolysis|beta-hemolytic]] [[streptococci]], ''[[Staphylococcus aureus]],'' | [[Hemolysis|beta-hemolytic]] [[streptococci]], ''[[Staphylococcus aureus]],'' | ||
[[fungi]] and [[viruses]]. | [[fungi]] and [[viruses]]. | ||
|[[Cyanosis]], [[Cervical]] [[lymphadenopathy]], | |[[Cyanosis]], [[Cervical]] [[lymphadenopathy]], [[Inflamed]] [[epiglottis]] | ||
|Used to be mostly found in | |Used to be mostly found in | ||
pediatric age group between 3 to 5 years, | pediatric age group between 3 to 5 years, | ||
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with a mean age of 44.94 years | with a mean age of 44.94 years | ||
|[[Thumbprint sign]] on neck x-ray | |[[Thumbprint sign]] on neck x-ray | ||
|Airway maintenance, | |[[Airway]] maintenance, [[Parenteral|parenteral]] [[Cefotaxime]] or [[Ceftriaxone]] in combination with [[Vancomycin]]. [[Adjuvant therapy]] includes [[corticosteroids]] and [[racemic]] [[Epinephrine]].<ref name="pmid15983574" /><ref name="pmid12557859" /> | ||
|- | |- | ||
|[[Pharyngitis]] | |[[Pharyngitis]] | ||
|[[Sore throat]], pain on swallowing, [[fever]], [[headache]], [[ | |[[Sore throat]], pain on swallowing, [[fever]], [[headache]], [[abdominal pain]], [[nausea]] and [[vomiting]] | ||
|[[Group A beta-hemolytic streptococci|Group A beta-hemolytic]] | |[[Group A beta-hemolytic streptococci|Group A beta-hemolytic]] | ||
[[Group A beta-hemolytic streptococci|streptococcus]]. | [[Group A beta-hemolytic streptococci|streptococcus]]. | ||
| | |[[Inflamed]] [[pharynx]] with or without [[exudate]] | ||
|Mostly in children and young adults, | |Mostly in children and young adults, | ||
with 50% of cases identified | with 50% of cases identified | ||
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|- | |- | ||
|[[Tonsilitis]] | |[[Tonsilitis]] | ||
|[[Sore throat]], pain on swallowing, [[fever]], [[headache]], [[cough]] | |[[Sore throat]], pain on swallowing, [[fever]], [[headache]], and [[cough]] | ||
|Most common cause is | |Most common cause is | ||
viral including [[adenovirus]], | [[viral]] including [[adenovirus]], | ||
[[rhinovirus]], [[influenza]], | [[rhinovirus]], [[influenza]], | ||
| Line 90: | Line 90: | ||
''[[Group A streptococcal infection|bacteria]]'',<ref name="pmid3601520" /> | ''[[Group A streptococcal infection|bacteria]]'',<ref name="pmid3601520" /> | ||
|[[Fever]], especially 100°F or higher.<ref name="Tonsillitis" /><ref name="urlTonsillitis - NHS Choices" />[[Erythema]], [[edema]] and [[ | |[[Fever]], especially 100°F or higher.<ref name="Tonsillitis" /><ref name="urlTonsillitis - NHS Choices" />[[Erythema]], [[edema]] and [[exudate]] of the [[tonsils]],<ref name="pmid25587367" /> cervical [[lymphadenopathy]], and [[Dysphonia]].<ref name="urlTonsillitis - Symptoms - NHS Choices" /> | ||
|Primarily affects children | |Primarily affects children | ||
between 5 and 15 years old.<ref name="Oroface" /> | between 5 and 15 years old.<ref name="Oroface" /> | ||
|Intraoral or transcutaneous USG may show an abscess making CT scan unnecessary.<ref name="pmid26527518" /><ref name="pmid25946659" /><ref name="pmid25945805" /> | |Intraoral or transcutaneous USG may show an [[abscess]] making CT scan unnecessary.<ref name="pmid26527518" /><ref name="pmid25946659" /><ref name="pmid25945805" /> | ||
|[[Antimicrobial]] therapy mainly [[penicillin]]-based and [[analgesics]] with [[tonsilectomy]] in selected cases. | |[[Antimicrobial]] therapy mainly [[penicillin]]-based and [[analgesics]] with [[tonsilectomy]] in selected cases. | ||
|- | |- | ||
|[[Retropharyngeal abscess]] | |[[Retropharyngeal abscess]] | ||
|[[Neck pain]], [[stiff neck]], [[torticollis]] | |[[Neck pain]], [[stiff neck]], [[torticollis]], [[fever]], [[malaise]], [[stridor]], and barking [[cough]] | ||
[[fever]], [[malaise]], [[stridor]], and barking [[cough]] | |||
|Polymicrobial infection. | |Polymicrobial infection. | ||
Mostly; [[Streptococcus pyogenes|Streptococcus]] | Mostly; [[Streptococcus pyogenes|Streptococcus]] | ||
[[Streptococcus pyogenes|pyogenes]], [[Staphylococcus aureus]] and respiratory anaerobes (example; Fusobacteria, [[Prevotella species|Prevotella]], | [[Streptococcus pyogenes|pyogenes]], [[Staphylococcus aureus]] and respiratory [[anaerobes]] (example; Fusobacteria, [[Prevotella species|Prevotella]], | ||
and Veillonella species)<ref name="pmid23520072" /><ref name="pmid22481424" /><ref name="pmid18948832" /><ref name="pmid15573356" /><ref name="pmid18427007" /><ref name="pmid2235179" /> | and Veillonella species)<ref name="pmid23520072" /><ref name="pmid22481424" /><ref name="pmid18948832" /><ref name="pmid15573356" /><ref name="pmid18427007" /><ref name="pmid2235179" /> | ||
|Child may be unable to open the mouth widely. May have enlarged | |Child may be unable to open the mouth widely. May have enlarged [[cervical]] [[lymph nodes]] and neck mass. | ||
[[cervical]] [[lymph nodes]] and neck mass. | |||
|Mostly between 2-4 years, but can occur in other age groups.<ref name="pmid12777558" /><ref name="pmid1876473" /> | |Mostly between 2-4 years, but can occur in other age groups.<ref name="pmid12777558" /><ref name="pmid1876473" /> | ||
|On CT scan, a mass impinging on the posterior pharyngeal wall with rim enhancement is seen<ref name="pmid15667676" /><ref name="pmid12761699" /> | |On CT scan, a mass impinging on the posterior [[pharyngeal]] wall with rim enhancement is seen<ref name="pmid15667676" /><ref name="pmid12761699" /> | ||
|Immediate surgical drainage and antimicrobial therapy. emperic therapy involves; [[ampicillin]]-[[sulbactam]] or [[clindamycin]]. | |Immediate surgical drainage and antimicrobial therapy. emperic therapy involves; [[ampicillin]]-[[sulbactam]] or [[clindamycin]]. | ||
|} | |} | ||
Revision as of 19:52, 7 March 2017
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Peritonsillar abscess Microchapters |
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Peritonsillar abscess differential diagnosis On the Web |
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American Roentgen Ray Society Images of Peritonsillar abscess differential diagnosis |
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Risk calculators and risk factors for Peritonsillar abscess differential diagnosis |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Prince Tano Djan, BSc, MBChB [2]
Overview
Peritonsillar abscess must be differentiated from other upper respiratory diseases and conditions that may cause throat pain and airway obstruction. These include; croup(laryngotracheobronchitis), pharyngitis, tonsilitis, retropharyngeal abscess and epiglottitis.
Differential diagnosis
Peritonsillar abscess must be differentiated from other upper respiratory diseases and conditions that may cause throat pain and airway obstruction as shown in the table below:
| Disease/Variable | Presentation | Causes | Physical exams findings | Age commonly affected | Imaging finding | Treatment |
|---|---|---|---|---|---|---|
| Peritonsillar abscess | Severe sore throat, otalgia fever, a "hot potato" or muffled voice, drooling, and trismus[1] | Aerobic and anaerobic | Contralateral deflection of the uvula,
the tonsil is displaced inferiorly and medially, tender submandibular and anterior cervical lymph nodes, tonsillar hypertrophy with likely peritonsillar edema. |
The highest occurrence is in adults between 20 to 40 years of age.[1] | On ultrasound peritonsillar abscess appears as focal irregularly marginated hypoechoic area.[6][7][8][9][6][7] | Ampicillin-sulbactam, Clindamycin, Vancomycin or Linezolid |
| Croup | Has cough and stridor but no drooling. Others are Hoarseness, Difficulty breathing, symptoms of the common cold, Runny nose, Fever | Parainfluenza virus | Suprasternal and intercostal indrawing,[10] Inspiratory stridor[11], expiratory wheezing,[11] Sternal wall retractions[12] | Mainly 6 months and 3 years old
rarely, adolescents and adults[13] |
Steeple sign on neck X-ray | Dexamethasone and nebulised epinephrine |
| Epiglottitis | Stridor and drooling but no cough. Other symptoms include difficulty breathing, fever, chills, difficulty swallowing, hoarseness of voice | H. influenza type b, | Cyanosis, Cervical lymphadenopathy, Inflamed epiglottis | Used to be mostly found in
pediatric age group between 3 to 5 years, however, recent trend favors adults as most commonly affected individuals[14] with a mean age of 44.94 years |
Thumbprint sign on neck x-ray | Airway maintenance, parenteral Cefotaxime or Ceftriaxone in combination with Vancomycin. Adjuvant therapy includes corticosteroids and racemic Epinephrine.[15][16] |
| Pharyngitis | Sore throat, pain on swallowing, fever, headache, abdominal pain, nausea and vomiting | Group A beta-hemolytic | Inflamed pharynx with or without exudate | Mostly in children and young adults,
with 50% of cases identified between the ages of 5 to 24 years.[17] |
_ | Antimicrobial therapy mainly penicillin-based and analgesics. |
| Tonsilitis | Sore throat, pain on swallowing, fever, headache, and cough | Most common cause is
viral including adenovirus, coronavirus, and Second most common causes are bacterial; |
Fever, especially 100°F or higher.[19][20]Erythema, edema and exudate of the tonsils,[21] cervical lymphadenopathy, and Dysphonia.[22] | Primarily affects children
between 5 and 15 years old.[23] |
Intraoral or transcutaneous USG may show an abscess making CT scan unnecessary.[24][25][26] | Antimicrobial therapy mainly penicillin-based and analgesics with tonsilectomy in selected cases. |
| Retropharyngeal abscess | Neck pain, stiff neck, torticollis, fever, malaise, stridor, and barking cough | Polymicrobial infection.
Mostly; Streptococcus pyogenes, Staphylococcus aureus and respiratory anaerobes (example; Fusobacteria, Prevotella, |
Child may be unable to open the mouth widely. May have enlarged cervical lymph nodes and neck mass. | Mostly between 2-4 years, but can occur in other age groups.[32][33] | On CT scan, a mass impinging on the posterior pharyngeal wall with rim enhancement is seen[34][35] | Immediate surgical drainage and antimicrobial therapy. emperic therapy involves; ampicillin-sulbactam or clindamycin. |