COTW 10/27/22 28 yo F presents for evaluation of muffled voice and sore throat

A 28 year old Female presents for evaluation of muffled voice, sore throat and pain with opening her mouth. She states that she has had sore throat for the past week and over the last 3 days she has progressive onset of muffled voice, sore throat and now has pain with opening her mouth. Her vitals are noteable for a low grade fever and on exam you notice some left sided tonsillar swelling with mild uvular deviation, but the right seems kind of swollen too. She has no signs and symptoms of deep neck space infection. To further charchterize what you are seeing you decided to use your trusty ultrasound….

Anechoic fluid collection starting at aprox 4.5 cm in depth

Left Peritonsilar abscess measuring 1.34 cm.

Abnormal seen on left.

To obtain the images seen above place your probe underneath the mandible and fan slightly upwards. You can also put color doppler over the hypoechoic area to better characterize what you are visualizing. This technique would be particularly useful in pediatric patients, especially given that the fluid collection would not be as deep as it would be in an adult.

To see the peritonsillar fluid collection you may need to fan slightly upwards

If your patient has above average neck soft tissue, it may be difficult to visualize a PTA through the neck soft tissues. You can alternatively use an endocavitary probe and with a transoral approach visualize the fluid collection. Obviously, please anesthetize the area you are scanning prior to performing the procedure.

Heterogenous fluid collection along the left tonsil.

While not the diagnostic modality of choice, you may be able to visualize deep neck space infections as well-simply slide your probe down the neck to the level of the cords and fan upwards.

Case Resolution

The patient was given steroids, antibiotics, and analgesics. She was observed in the ED and had marked improvement in her symptoms and was discharged with antibiotics and close ENT followup.