Our case would support the need for a high index of suspicion when findings are not classic for peritonsillar abscess
with consideration of imaging and/or a surgical procedure.
Pathological radio-opaque calcifications simulating tonsilloliths are of vasculature (atherosclerosis or phleboliths), lymph node calcification, calcified peritonsillar abscess
, salivary gland sialolith or an intraosseous abnormality within the mandibular ramus.
Contrast-enhanced CT of the neck and chest revealed a large right-sided peritonsillar abscess
(Figure 1), thrombus along the anterior aspect of the right internal jugular vein (Figure 2), and multiple septic pulmonary emboli (Figure 3).
New trends in the management of peritonsillar abscess
Some 11% of these patients had previously undergone surgery of some sort--the most common being adenoidectomy (48%), incision and drainage of a peritonsillar abscess
(15%), hernia repair (13%), dental procedures (13%), and orthopedic procedures (9%).
Mediastinal abscess is a rare yet emergent infection of the thoracic cavity connective tissue, resulting from multiple potential sources: esophageal perforation (Boerhaave's syndrome), odontogenic and peritonsillar abscess
(descending necrotizing mediastinitis), cardiovascular or thoracic surgical procedures, trauma or rarely due to hematogenous spread (1,2).
An abscess in this space may arise from direct extension of infection from the pharynx through the pharyngeal wall, as a consequence of odontogenic infection, local trauma, and occasionally peritonsillar abscess
Two of his strep throat infections had been associated with the formation of a peritonsillar abscess
on the right side that required drainage.
Twelve had concomitant parapharyngeal abscess and one had concomitant peritonsillar abscess
1) An aberrant ICA is susceptible to devastating injury during routine ENT procedures such as tonsillectomy and drainage of peritonsillar abscess
List of possible diagnoses included on the form used in the present study Laryngomalacia Retropharyngeal abscess Tracheomalacia Laryngeal stenosis Croup Subglottic stenosis Micrognathia Acute pharyngitis Macroglossia Papillomas (upper airway) Vascular compression Choanal atresia Adenotonsillar Vocal fold paralysis hypertrophy Peritonsillar abscess
Parapharyngeal Normal abscess URI Figure.
If trismus is present, a peritonsillar abscess
should be suspected.