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Peritonsillar abscess
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Peritonsillar abscess

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Contributors: Neil Mendoza MD, Paritosh Prasad MD
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Synopsis

Peritonsillar abscess, also known as quinsy, is a deep neck space infection characterized by a collection of pus in the peritonsillar space.

This infection develops as a suppurative complication of acute tonsillitis or pharyngitis.

As with other deep neck space infections, peritonsillar abscesses are frequently polymicrobial in nature and consist of mouth flora. Some important pathogens to consider when choosing empiric antibiotics include Group A Streptococcus, Staphylococcus aureus, Haemophilus, and Fusobacterium.

Patients present with a muffled voice, fever, sore throat, and dysphagia. There is deviation of the uvula to the unaffected side. Trismus and otalgia may be present. This infection usually affects young adults, but all ages can be affected. Older adults may have more subtle symptoms. Laboratory findings include leukocytosis. Treatment consists of antibiotic therapy and surgical drainage.

Complications of this infection include airway obstruction or extension of the infection into contiguous spaces in the neck.

Codes

ICD10CM:
J36 – Peritonsillar abscess

SNOMEDCT:
15033003 – Peritonsillar abscess

Look For

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

  • Tonsillitis – not associated with an abscess cavity (in some cases, imaging may be necessary to make this distinction)
  • Pharyngitis (bacterial including streptococcal, viral) – not associated with an abscess cavity
  • Mononucleosis – heterophile antibody or other testing for mononucleosis could be performed
  • Parapharyngeal or retropharyngeal abscess – CT scan of the neck will be able to demarcate the anatomic areas of involvement of the infection.
  • Ludwig angina (see cellulitis in Oral Mucosal Lesion) – CT scan of the neck will be able to demarcate the anatomic areas of involvement of the infection. Patients usually have submandibular swelling.
  • Dental abscess – not typically associated with tonsillar swelling
  • Malignancy (particularly primary tonsillar carcinomas, lymphomas, oropharyngeal carcinomas) – requires a biopsy to make a definitive diagnosis
  • Epiglottitis – not typically associated with tonsillar swelling
  • Diphtheria – look for the classic membrane associated with this infection
  • Acute human immunodeficiency virus infection – commonly presents with pharyngitis, but there should not be an associated abscess

Best Tests

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Management Pearls

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Therapy

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References

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Last Updated: 10/27/2016
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Peritonsillar abscess
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Peritonsillar abscess : Cervical lymphadenopathy, Fever, Drooling, Hoarseness, Pharyngitis, Trismus
Imaging Studies image of Peritonsillar abscess
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