Throat Abscess Differentiation

Throat Abscess Differentiation Posted By:
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Deep neck space infections are frequently seen in medical clinics and EDs despite the advent of antibiotics. They most commonly arise from a septic focus of the mandibular teeth, tonsils, parotid gland, deep cervical lymph nodes, middle ear, or sinuses. They often have a rapid onset and can progress to life-threatening complications. A vast majority of providers are unfamiliar with these conditions since, in all likelihood, they have never seen one in person. In addition, the classic manifestations of these infectionssuch as high fever, systemic toxicity, and local signs of erythema, edema, and fluctuancemay be absent. Thus, providers must remain vigilant for such infections and should not underestimate their potential extent or severity.

The following chart briefly gives an overview of the three abscesses, including their most common presentations, diagnosis, and treatment (not all inclusive).

Peritonsillar Abscess

Parapharyngeal Abscess

Retropharyngeal Abscess

Epidemiology

Most common in adolescents and young adults

It is the most common of the deep neck infections

Most common in children <5 years of age but can be seen in adults

Immunocompromised adults are also at an increased risk

Most common in children <5 years of age but can also occur in adults

Etiology

Acute tonsillitis

Dental infections (most common)

Acute tonsillitis

Peritonsillar abscess

Pharyngeal or salivary gland infections

Secondary to penetrating neck trauma

Iatrogenic (eg, injection of local anesthetic for nerve block)

Contiguous or lymphatic spread from upper respiratory tract infections (most common) or other nearby infections

Local penetrating pharyngeal trauma

Clinical Features

Features of tonsillitis "hot potato" voice & trismus

Uvula shifted to the contralateral side

Inflamed ipsilateral tonsil that is fluctuant, edematous, and erythematous with exudates (ipsilateral bulging of the palatine arch)

Features of tonsillitis

Sometimes trismus

Medial displacement of the lateral pharyngeal wall and tonsil (posterior space abscess) or indurated edema below the angle of the mandible down to the hyoid bone (anterior space abscess)

Features of tonsillitis

Sometimes trismus

Unilateral swelling of the posterior pharyngeal wall (possible fluctuance)

Neck asymmetry with neck swelling and anterior cervical lymphadenopathy (which leads to an inability to extend the neck)

Diagnosis

Clinical diagnosis or CT (with contrast)

CT (with contrast)

Lateral x-ray: widened prevertibral (soft tissue) space or CT (with contrast)

Treatment

Parenteral antibiotics & surgical drainage (all three conditions)

 

References

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