Peritonsillar abscess differential diagnosis: Difference between revisions
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Prince Djan (talk | contribs) Created page with "__NOTOC__ {{Peritonsillar abscess}} {{CMG}} {{AE}} {{PTD}} ==Overview== ==Differential diagnosis== ==References== {{Reflist|2}} {{WH}} {{WS}}" |
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==Differential diagnosis== | ==Differential diagnosis== | ||
{| class="wikitable" | |||
!Disease/Variable | |||
!Presentation | |||
!Causes | |||
!Physical exams findings | |||
!Age commonly affected | |||
!Imaging finding | |||
!Treatment | |||
|- | |||
|[[Peritonsillar abscess]] | |||
|Severe [[sore throat]], [[otalgia]] [[fever]], a "hot potato" or muffled voice, [[drooling]], and [[trismus]]<ref name="pmid18246890" /> | |||
|[[Streptococcus pyogenes|Aerobic and anaerobic]] | |||
[[Streptococcus pyogenes|bacteria most common is]] | |||
[[Streptococcus pyogenes|Streptococcus]] | |||
[[Streptococcus pyogenes|pyogenes]].<ref name="pmid15573356" /><ref name="pmid18039418" /><ref name="pmid1875138" /><ref name="pmid12092281" /> | |||
|[[Contralateral]] deflection of the uvula, | |||
the [[tonsil]] is displaced [[inferiorly]] and [[medially]], tender [[submandibular]] and [[anterior]] [[cervical lymph nodes|cervical lymph nodes,]] [[Tonsillar abscess|tonsillar]] [[hypertrophy]] with likely peritonsillar [[edema]]. | |||
|The highest occurrence is in adults between 20 to 40 years of age.<ref name="pmid18246890" /> | |||
|On ultrasound peritonsillar abscess appears as focal irregularly marginated hypoechoic area.<ref name="pmid15635144" /><ref name="pmid1642863" /><ref name="pmid26637999" /><ref name="pmid10435129" /><ref name="pmid15635144" /><ref name="pmid1642863" /> | |||
|[[Ampicillin-sulbactam|Ampicillin-sulbactam,]] [[Clindamycin]], [[Vancomycin]] or [[Linezolid]] | |||
|- | |||
|[[Croup]] | |||
|Has [[cough]] and [[stridor]] but no [[drooling]]. Others are [[Hoarseness]], [[Difficulty breathing]], symptoms of the [[common cold]], [[Runny nose]], [[Fever]] | |||
|[[Parainfluenza virus]] | |||
|Suprasternal and [[intercostal]] [[Indrawing|indrawing,]]<ref name="pmid19445760" /> Inspiratory [[stridor]]<ref name="Cherry2008" />, expiratory [[wheezing]],<ref name="Cherry2008" /> [[Sternal]] wall retractions<ref name="pmid194457602" /> | |||
|Mainly 6 months and 3 years old | |||
rarely, adolescents and adults<ref name="pmid8769531" /> | |||
|[[Steeple sign]] on neck X-ray | |||
|[[Dexamethasone]] and nebulised [[epenephrine|epinephrine]] | |||
|- | |||
|[[Epiglottitis]] | |||
|Has [[stridor]] and [[drooling]] [[Difficulty breathing|but no cough. Other symptoms include difficulty breathing]], [[Difficulty swallowing|fever, chills, difficulty swallowing]], [[hoarseness]] of voice | |||
|[[Hemolysis|H. influenza type b,]] | |||
[[Hemolysis|beta-hemolytic]] [[streptococci]], ''[[Staphylococcus aureus]],'' | |||
[[fungi]] and [[viruses]]. | |||
|[[Cyanosis]], [[Cervical]] [[lymphadenopathy]], Inflammed [[epiglottis]] | |||
|Used to be mostly found in | |||
pediatric age group between 3 to 5 years, | |||
however, recent trend favors adults | |||
as most commonly affected individuals<ref name="pmid270310102" /> | |||
with a mean age of 44.94 years | |||
|[[Thumbprint sign]] on neck x-ray | |||
|Airway maintenance, p[[Parenteral|arenteral]] [[Cefotaxime]] or [[Ceftriaxone]] in combination with [[Vancomycin]]. Adjuvant therapy includes [[corticosteroids]] and [[racemic]] [[Epinephrine]].<ref name="pmid15983574" /><ref name="pmid12557859" /> | |||
|- | |||
|[[Pharyngitis]] | |||
|[[Sore throat]], pain on swallowing, [[fever]], [[headache]], [[Abdominal pain|abdominal]] pain, [[nausea]] and [[vomiting]] | |||
|[[Group A beta-hemolytic streptococci|Group A beta-hemolytic]] | |||
[[Group A beta-hemolytic streptococci|streptococcus]]. | |||
|Inflammed [[pharynx]] with or without [[exudate]] | |||
|Mostly in children and young adults, | |||
with 50% of cases identified | |||
between the ages of 5 to 24 years.<ref name=":0" /> | |||
|_ | |||
|[[Antimicrobial]] therapy mainly [[penicillin]]-based and [[analgesics]]. | |||
|- | |||
|[[Tonsilitis]] | |||
|[[Sore throat]], pain on swallowing, [[fever]], [[headache]], [[cough]] | |||
|Most common cause is | |||
viral including [[adenovirus]], | |||
[[rhinovirus]], [[influenza]], | |||
[[coronavirus]], and | |||
[[respiratory syncytial virus]]. | |||
Second most common | |||
causes are bacterial; | |||
''[[Group A streptococcal infection|Group A streptococcal]]'' | |||
''[[Group A streptococcal infection|bacteria]]'',<ref name="pmid3601520" /> | |||
|[[Fever]], especially 100°F or higher.<ref name="Tonsillitis" /><ref name="urlTonsillitis - NHS Choices" />[[Erythema]], [[edema]] and [[Exudate]] of the [[tonsils]].<ref name="pmid25587367" /> cervical [[lymphadenopathy]], [[Dysphonia]].<ref name="urlTonsillitis - Symptoms - NHS Choices" /> | |||
|Primarily affects children | |||
between 5 and 15 years old.<ref name="Oroface" /> | |||
|Intraoral or transcutaneous USG may show an abscess making CT scan unnecessary.<ref name="pmid26527518" /><ref name="pmid25946659" /><ref name="pmid25945805" /> | |||
|[[Antimicrobial]] therapy mainly [[penicillin]]-based and [[analgesics]] with [[tonsilectomy]] in selected cases. | |||
|- | |||
|[[Retropharyngeal abscess]] | |||
|[[Neck pain]], [[stiff neck]], [[torticollis]] | |||
[[fever]], [[malaise]], [[stridor]], and barking [[cough]] | |||
|Polymicrobial infection. | |||
Mostly; [[Streptococcus pyogenes|Streptococcus]] | |||
[[Streptococcus pyogenes|pyogenes]], [[Staphylococcus aureus]] and respiratory anaerobes (example; Fusobacteria, [[Prevotella species|Prevotella]], | |||
and Veillonella species)<ref name="pmid23520072" /><ref name="pmid22481424" /><ref name="pmid18948832" /><ref name="pmid15573356" /><ref name="pmid18427007" /><ref name="pmid2235179" /> | |||
|Child may be unable to open the mouth widely. May have enlarged | |||
[[cervical]] [[lymph nodes]] and neck mass. | |||
|Mostly between 2-4 years, but can occur in other age groups.<ref name="pmid12777558" /><ref name="pmid1876473" /> | |||
|On CT scan, a mass impinging on the posterior pharyngeal wall with rim enhancement is seen<ref name="pmid15667676" /><ref name="pmid12761699" /> | |||
|Immediate surgical drainage and antimicrobial therapy. emperic therapy involves; [[ampicillin]]-[[sulbactam]] or [[clindamycin]]. | |||
|} | |||
==References== | ==References== | ||
Revision as of 18:05, 2 March 2017
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Peritonsillar abscess Microchapters |
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Diagnosis |
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Treatment |
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Case Studies |
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Peritonsillar abscess differential diagnosis On the Web |
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American Roentgen Ray Society Images of Peritonsillar abscess differential diagnosis |
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Risk calculators and risk factors for Peritonsillar abscess differential diagnosis |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Prince Tano Djan, BSc, MBChB [2]
Overview
Differential diagnosis
| Disease/Variable | Presentation | Causes | Physical exams findings | Age commonly affected | Imaging finding | Treatment |
|---|---|---|---|---|---|---|
| Peritonsillar abscess | Severe sore throat, otalgia fever, a "hot potato" or muffled voice, drooling, and trismus[1] | Aerobic and anaerobic | Contralateral deflection of the uvula,
the tonsil is displaced inferiorly and medially, tender submandibular and anterior cervical lymph nodes, tonsillar hypertrophy with likely peritonsillar edema. |
The highest occurrence is in adults between 20 to 40 years of age.[1] | On ultrasound peritonsillar abscess appears as focal irregularly marginated hypoechoic area.[6][7][8][9][6][7] | Ampicillin-sulbactam, Clindamycin, Vancomycin or Linezolid |
| Croup | Has cough and stridor but no drooling. Others are Hoarseness, Difficulty breathing, symptoms of the common cold, Runny nose, Fever | Parainfluenza virus | Suprasternal and intercostal indrawing,[10] Inspiratory stridor[11], expiratory wheezing,[11] Sternal wall retractions[12] | Mainly 6 months and 3 years old
rarely, adolescents and adults[13] |
Steeple sign on neck X-ray | Dexamethasone and nebulised epinephrine |
| Epiglottitis | Has stridor and drooling but no cough. Other symptoms include difficulty breathing, fever, chills, difficulty swallowing, hoarseness of voice | H. influenza type b, | Cyanosis, Cervical lymphadenopathy, Inflammed epiglottis | Used to be mostly found in
pediatric age group between 3 to 5 years, however, recent trend favors adults as most commonly affected individuals[14] with a mean age of 44.94 years |
Thumbprint sign on neck x-ray | Airway maintenance, parenteral Cefotaxime or Ceftriaxone in combination with Vancomycin. Adjuvant therapy includes corticosteroids and racemic Epinephrine.[15][16] |
| Pharyngitis | Sore throat, pain on swallowing, fever, headache, abdominal pain, nausea and vomiting | Group A beta-hemolytic | Inflammed pharynx with or without exudate | Mostly in children and young adults,
with 50% of cases identified between the ages of 5 to 24 years.[17] |
_ | Antimicrobial therapy mainly penicillin-based and analgesics. |
| Tonsilitis | Sore throat, pain on swallowing, fever, headache, cough | Most common cause is
viral including adenovirus, coronavirus, and Second most common causes are bacterial; |
Fever, especially 100°F or higher.[19][20]Erythema, edema and Exudate of the tonsils.[21] cervical lymphadenopathy, Dysphonia.[22] | Primarily affects children
between 5 and 15 years old.[23] |
Intraoral or transcutaneous USG may show an abscess making CT scan unnecessary.[24][25][26] | Antimicrobial therapy mainly penicillin-based and analgesics with tonsilectomy in selected cases. |
| Retropharyngeal abscess | Neck pain, stiff neck, torticollis | Polymicrobial infection.
Mostly; Streptococcus pyogenes, Staphylococcus aureus and respiratory anaerobes (example; Fusobacteria, Prevotella, |
Child may be unable to open the mouth widely. May have enlarged
cervical lymph nodes and neck mass. |
Mostly between 2-4 years, but can occur in other age groups.[32][33] | On CT scan, a mass impinging on the posterior pharyngeal wall with rim enhancement is seen[34][35] | Immediate surgical drainage and antimicrobial therapy. emperic therapy involves; ampicillin-sulbactam or clindamycin. |