What is the role of imaging studies in the workup of peritonsillar abscesses (PTAs)?

Updated: Sep 03, 2020
  • Author: Jorge Flores, MD; Chief Editor: Jeter (Jay) Pritchard Taylor, III, MD  more...
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Lateral soft tissue neck radiographs may help rule out other causes. The anteroposterior (AP) view of the neck may demonstrate distortion of soft tissue.

A study by Huang et al indicated that ultrasonography is an accurate means of evaluating patients for peritonsillar abscess, finding that compared with patients diagnosed with peritonsillar abscess via traditional examination methods and/or CT scanning, those who were diagnosed with transcervical ultrasonography demonstrated significant reductions in surgical drainage and length of hospital stay. [17]

Intraoral ultrasonography (US) has a sensitivity of 95.2% and specificity of 78.5%. This method is cost-effective and fast, although it does require a cooperative patient. A study carried out at an academic level I emergency department included 43 patients who received intraoral US for suspected peritonsillar abscess. Thirty-five were diagnosed with an abscess on US, and these patients subsequently received needle aspiration using US guidance. There was one false positive, but no patients returned unexpectedly after drainage, and, on reexamination, there was no evidence of persistent or recurrent peritonsillar abscess or cellulitis. This study supports the use of US for both the diagnosis and treatment of peritonsillar abscesses. [18]

Another study demonstrated that intraoral US can reliably distinguish peritonsillar abscess from peritonsillar cellulitis; this not only helps direct treatment, but it also results in fewer CT scans of the neck and fewer ENT consultations. [19] Prior studies of US use have shown similar successful results.

Head and neck CT scanning with intravenous (IV) contrast is useful if incision and drainage fails, if the patient cannot open his or her mouth, or if the patient is young (age < 7 years) and uncooperative. A hypodense fluid collection with rim enhancement may be seen in the affected tonsil. Foreign bodies, such as fish or chicken bones, may also be found as an inciting factor.

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