BACKGROUND AND OBJECTIVES: Clinical differentiation of peritonsillar abscess from peritonsillar cellulitis can be difficult and often relies on diagnostic needle aspiration that is invasive. The differential diagnosis of the two conditions is very important for the planning of treatment. This study is to evaluate the usefulness of gray scale image (GSI) and color doppler image (CDI) using intraoral ultrasonography in differential diagnosis of the peritonsillar abscess from peritonsillar cellulitis. MATERIALS AND METHODS: Twenty patients with suspected peritonsillar abscess were included in this study. GSI and CDI of the intraoral ultrasonography with 7-MHz curved linear array transducer were used. RESULTS: The peritonsillar abscess showed inhomogeneously hypoechoic or cystic space on GSI and rim-shaped color flow signal on CDI. The peritonsillar cellulitis showed homogeneously hypoechoic or striated textual appearance on GSI and diffusely increased color signal on CDI. The sensitivity of GSI for diagnosis of peritonsillar abscess and peritonsillar cellulitis was 91.7% and 77.8%, respectively, whereas the specificiy of CDI proved to be 100% for the diagnosis of both conditions. CONCLUSION: This study demonstrates that intraoral ultrasonography is a useful and noninvasive technique for diagnosis of peritonsillar abscess.
Cellulitis ; Diagnosis* ; Diagnosis, Differential ; Humans ; Needles ; Peritonsillar Abscess* ; Transducers ; Ultrasonography*

Diagnostic Errors ; Humans ; Lymphoma, Large B-Cell, Diffuse/diagnosis* ; Peritonsillar Abscess/diagnosis*

Kawasaki disease (KD) causes multisystemic vasculitis but infrequently manifests with deep neck infections, such as a peritonsillar abscess, peritonsillar or deep neck cellulitis, suppurative parapharyngeal infection, or retropharyngeal abscess. As its etiology is still unknown, the diagnosis is usually made based on typical symptoms. The differential diagnosis between KD and deep neck infections is important, considering the variable head and neck manifestations of KD. There are several reports on KD patients who were initially diagnosed with retropharyngeal abscess on on computed tomography scans (CT). However, the previously reported cases did not have abscess or fluid collection on retropharyngeal aspiration. Therefore, false-positive neck CT scans have been obtained, until recently. In this case, suspected neck abscess in patients with KD unresponsive to intravenous immunoglobulin could signal the possible coexistence of suppurative cervical lymphadenitis.
Abscess ; Cellulitis ; Child ; Diagnosis, Differential ; Drainage ; Head ; Humans ; Immunoglobulins ; Lymphadenitis ; Mucocutaneous Lymph Node Syndrome ; Neck ; Peritonsillar Abscess ; Retropharyngeal Abscess ; Vasculitis

A peritonsillar abscess is one of the most commonly occurring deep space infections of the head and neck in adults and children. A peritonsillar abscess that appears in newborns, however, is extremely rare. The treatment of a peritonsillar abscess requires both the selection of appropriate antibiotics and the best procedure to remove the abscessed material. We report a case of a peritonsillar abscess in a 40-day-old infant who was treated with antibiotic therapy alone.
Tonsillectomy ; Tomography, X-Ray Computed ; Peritonsillar Abscess/*diagnosis/*radiography/therapy ; Male ; Infant ; Humans

BACKGROUND AND OBJECTIVES: Diagnostic features of peritonsillar abscess are an asymmetrically enlarged palatine tonsil with peripheral rim enhancement and central low density in the post-contrast computed tomography (CT). Although it is necessary to differentiate tumorous conditions of tonsils to compare pre- and post-contrast CT, pre-contrast CT may be less useful in the diagnosis of peritonsillar abscess. This study aims to evaluate of the efficacy of single post-contrast CT for diagnosis and treatment of peritonsillar abscess. SUBJECTS AND METHOD: We retrospectively compared 29 patients with peritonsillar abscess, who were diagnosed by single post-contrast CT, with 36 patients diagnosed by pre- and post-contrast CT to determine the success rates of pus drainage and hospital days. Additionally, two otorhinolaryngologists made a judgment of abscess presence for sixty randomly mixed CT images of peritonsillar abscess or tonsillitis with pre- and post-contrast CT or single post-contrast CT. RESULTS: There were no significant differences in the success rate of drainage (p=0.622) and hospital days (p=0.504) between groups with/without pre-contrast CT. Abscess presence was judged by raters with/without pre-contrast CT. Inter-rater agreement value (Cohen's kappa) was 0.825 (p<0.01). CONCLUSION: Single post-contrast CT of peritonsillar abscess may be a good alternative for diagnosis and treatment and may reduce unnecessary exposure to radiation.
Abscess ; Contrast Media ; Diagnosis ; Drainage ; Humans ; Judgment ; Methods ; Palatine Tonsil ; Peritonsillar Abscess ; Retrospective Studies ; Sensitivity and Specificity ; Suppuration ; Tonsillitis

Lemierre's syndrome is very rare and is characterized by previous oropharyngeal infections, such as pharyngitis or peritonsillar abscess, leading to high fever, internal jugular venous thrombosis, and metastatic infections to multiple internal organs. Prompt and accurate diagnosis followed by early treatment with antibiotics is very important because its mortality is high if treatment is delayed. We report on the case of a 23-year-old female who was transferred to our hospital with a left peritonsillar abscess combined with left jugular venous thrombosis, complaining of a sore throat and left submandibular swelling, and diagnosed as Lemierre's syndrome. Finally, she was treated successfully without anticoagulants.
Anti-Bacterial Agents ; Anticoagulants ; Diagnosis ; Female ; Fever ; Humans ; Lemierre Syndrome* ; Mortality ; Peritonsillar Abscess* ; Pharyngitis ; Venous Thrombosis ; Young Adult

Gossypiboma is the term used to describe mass lesion caused by retained surgical sponges with reactive tissue after a surgical intervention. This condition has been mostly reported after abdominal or thoracic surgery. We recently experienced a case of gossypiboma of the peritonsillar space in a 31-year old male patient, who previously undergone incision and drainage for treatment of peritonsillar abscess but had persistent symptom of sore throat, myalgia and febrile sensation for 6 months. The gauze was accidently left in the peritonsillar space after a surgical intervention and resulted in mass like lesion in the ipsilateral peritonsillar space. To our knowledge, this is the first case of oropharyngeal gossypiboma in the literature. Although it is rare in adults, foreign body of peritonsillar space should be considered in the differential diagnosis of unilateral recurrent tonsillitis.
Adult ; Diagnosis, Differential ; Drainage ; Foreign Bodies ; Humans ; Male ; Palatine Tonsil ; Peritonsillar Abscess ; Pharyngitis ; Sensation ; Surgical Sponges ; Thoracic Surgery ; Tonsillectomy ; Tonsillitis

Peritonsillar abscess is a common deep throat infection. Early diagnosis and prompt, appropriate management of a peritonsillar abscess prevents mortality. A 45-year-old woman on steroids for an ulcerative colitis (UC) exacerbation presented with sore throat and multiple skin ulcers on her left forearm and right foot. Computed tomography of the neck revealed a peritonsillar abscess. Gram staining and culture of the abscess were negative, and a skin biopsy suggested pyoderma gangrenosum (PG). The final diagnosis was peritonsillar involvement of steroid-refractory PG-associated UC. The patient showed a complete response to infliximab. Here, we report a case of successful infliximab treatment for peritonsillar involvement of steroid-refractory PG-associated UC.
Abscess ; Biopsy ; Colitis, Ulcerative* ; Diagnosis ; Early Diagnosis ; Female ; Foot ; Forearm ; Humans ; Infliximab ; Middle Aged ; Mortality ; Neck ; Peritonsillar Abscess ; Pharyngitis ; Pharynx ; Pyoderma Gangrenosum* ; Skin ; Skin Ulcer ; Steroids

Arcanobacterium haemolyticum is a cause of chronic skin ulcers in diabetic patients and respiratory infection, especially pharyngitis in healthy person. Less frequently, it is a cause of osteomyelitis, meningitis, pneumonia, abscess, endocarditis and sepsis. We isolated A. haemolyticum from 5 patients including foot or back ulceration in 3 diabetic patients, wound on calcaneus in a chronic osteomyelitis patient and peritonsillar abscess in a pharyngitis patient. A. haemolyticum is usually isolated with other microorganisms and coryneform bacilli which are often considered to be nonpathogenic normal flora or contaminants in wound infections. The correct diagnosis of this microorganism is important for proper treatment and prevention of serious infections.
Abscess ; Arcanobacterium* ; Calcaneus ; Diagnosis ; Endocarditis ; Foot ; Humans ; Meningitis ; Osteomyelitis ; Peritonsillar Abscess* ; Pharyngitis ; Pneumonia ; Sepsis ; Skin Ulcer* ; Ulcer ; Wound Infection ; Wounds and Injuries

Descending necrotizing mediastinitis(DNM) is a rare complication of the oropharyngeal and cervical infection. Descending necrotizing mediastinitis requires an early and aggressive surgical approach to reduce the high morbidity and mortality associated with this disease. A 39-year-old man complained of odynophagia, neck swelling, and disturbance of swallowing with dyspnea. CT scans of the neck suggested a peritonsillar abscess and retropharyngeal and peripharyngeal abscess. He underwent cervical drainage. He remained febrile and complained of severe both pain in both shoulders. On postoperative day 5, a follow-up CT scan confirmed a mediastinal abscess. Reexploration of the neck and right thoracotomy for debridement and drainage of the mediastinal abscess were performed. A large amount of pus was drained from the anterior and posterior mediastinum and its necrotic tissue was debrided. The patient's condition and radiologic findings gradually improved. Cultures of the drain fluid revealed Klebsiella pneumoniae. He was discharged on the 85th hospital day. In our experience, both transcervical drainage and aggressive mediastinal exploration via thoracotomy can lead to an improvement in the survival of the patient with descending necrotizing mediastinitis. CT scanning is useful for early diagnosis of mediastinitis and for follow up.
Abscess ; Adult ; Debridement ; Deglutition ; Drainage ; Dyspnea ; Early Diagnosis ; Follow-Up Studies ; Humans ; Klebsiella pneumoniae ; Mediastinitis* ; Mediastinum ; Mortality ; Neck ; Peritonsillar Abscess* ; Shoulder ; Suppuration ; Thoracotomy ; Tomography, X-Ray Computed