Imaging

Peritonsillar abscess

Preliminary Diagnosis: Peritonsillar abscess

I. What imaging technique is first-line for this diagnosis?

  • CT soft tissue neck with contrast

II. Describe the advantages and disadvantages of this technique for diagnosis of peritonsillar abscess.

Advantages

  • Relatively inexpensive, fast imaging modality.

  • Able to differentiate neck pathology from adjacent vascular structures, lymph nodes, and osseous structures with great specificity and sensitivity.

  • Delineates extension of inflammatory process into different spaces of the neck

Disadvantages

  • Exposes patients to ionizing radiation

  • Less sensitive and specific for detailing any subtle edema in the adjacent osseous structures to suggest early osteomyelitis

III. What are the contraindications for the first-line imaging technique?

  • May be contraindicated in pregnant patients

IV. What alternative imaging techniques are available?

  • Contrasted MR of the neck

V. Describe the advantages and disadvantages of the alternative techniques for diagnosis of peritonsillar abscess.

Contrasted MR of the Neck

Advantages

  • Does not expose the patient to ionizing radiation.

  • More sensitive to detecting early surrounding osseous edema to suggest secondary osteomyelitis

Disadvantages

  • Less adept in detailing and differentiating the soft tissue pathology from adjacent vascular structures, lymph nodes, and osseous structures

  • Expensive

  • Time consuming

  • Requires significant patient cooperation to minimize motion artifact

VI. What are the contraindications for the alternative imaging techniques?

Contrasted MR of the Neck

  • Contraindicated in patients with non–MR-compatible hardware

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