Download POCUS for Peritonsillar Abscess

SONOGRAPHIC EVALUATION OF PERITONSILLAR ABSCESS
Ayomide Loye
PGY 1
PERITONSILLAR ABSCESS
•
Most common deep space infection of head and neck
• Incidence of 1 in 10,000.
•
Most common in adolescent with an antecedent sore throat
•
Clinical presentation: ill appearance with fevers, dysphagia/odonophagia, trismus,
drooling, peritonsillar erythema + swelling and muffled “hot potato” voice
•
Complications
• Rupture into airway
• Dissection into carotid
• Regional spread leading to sepsis.
ANATOMY OF A PERI-TONSILLAR ABSCESS
•
Pathophysiology: Inflammation of
minor salivary gland (Weber’s gland)
which lies superior to the tonsils.
•
Affected tonsil is anteriorly and
medially displaced.
•
Uvula displaced away from affected
side.
•
Carotid artery and jugular vein
located 2.5cm posterior and lateral to
tonsil
LANDMARK BASED PTA
ULTRASOUND GUIDED PTA DRAINAGE
•
Equipment
• Intraoral or Intracavitary probe.
•
Procedure and Technique
• Cover intracavitary probe with a layer of gel and probe cover
• With patient sitting up, insert probe into mouth to side of suspected abscess (Might
be helpful for patient to insert probe to prevent gagging and anxiety)
• Determine size and depth of fluid collection.
• Determine depth of carotid artery
• Chose appropriate needle length
•
Complications
• Rare. Mostly due to sonographic image misinterpretation.
STUDY CONCLUSION
•
Ultrasound established correct
diagnosis (PTA vs PTC) more than LM
•
More successful aspiration of purulent
material with US
•
ENT consult rate was 7% for US vs
50% for LM
•
CT usage rate was 0% for US vs 35%
for LM
ULTRASOUND VS CT SCAN
Prospective single cohort study where 24 patients were evaluated in the ED for
peritonsillar infection. Intraoral ultrasound was performed and presence or absence of
abscess was noted.
ULTRASOUND VS CLINICAL DIAGNOSIS VS CT
•
Scott et al: Prospective study with sample size of 14 patients to determine diagnosis of
peri-tonsilar infection using clinical diagnosis, ultrasound and CT.
•
Clinical impression
• Sensitivity: 78%
• Specificity: 50%
•
Ultrasound
• Sensitivity:89%
• Specificity:100%
•
Computerized tomography
• Sensitivity:100%
• Specificity:75%
•
Bottom Line: Intraoral US useful in improving accuracy in distinguishing abscess from
cellulitis
CONCLUSION
•
Ultrasound can improve accuracy of diagnosing PTA when used in conjunction with
clinical diagnosis
•
Ultrasound reduces the number of unnecessary needle aspiration attempts in patients
suspected of having PTA
•
Ultrasound led to more successful aspirations of PTA
•
Ultrasound can reliably rule out abscess making CT scan for diagnosis unnecessary
REFERENCES
•
1) Constantino T, Satz W, Dehnkamp W, Goett H. Randomized trial comparing intraoral
ultrasound to landmark-based needle aspiration in patients with suspected peritonsillar
abscess. Academic Emerg Med. 2012; 6:626-631.
•
2) Scott P.M., Loftus W.K., Kew J. et al. Diagnosis of peritonsillar infections: a prospective
study of ultrasound, computerized tomography and clinical diagnosis. J Laryngol Otol.
1999; 113:229–232.
•
3) Roberts J, Hedges J. Clinical Procedures in Emergency Medicine, 6th ed. Philadelphia,
PA: Saunders, 2014; 1282
•
4) Nogan S, Jandall D, Cipolla M, Desilva B. The use of ultrasound imaging in evaluation
of peritonsillar infection. Laryngoscope 2015 Nov; 125(11): 2604-7
•
5) Scott PM, Loftus WK, Kew J, Ahuja A, Yue V, van Hasselt CA. Diagnosis of peritonsillar
infection: a prospective study of ultrasound, computer tomography and clinical diagnosis.