Presentation
Five days sore throat. Significant anterior neck tenderness and decreased neck movement - ?abscess.
Patient Data
The palatine tonsils are enlarged and hyperemic bilaterally. There is low density edematous change within the parapharyngeal mucosal space, which causes mild narrowing of the upper oropharyngeal airway, and asymmetry of the hypopharynx, particularly on the left with asymmetry of the piriform fossa. No frank abscess formation is evident. The retropharyngeal space is unremarkable at this stage with, no evidence of a retropharyngeal abscess. A number of enlarged, probably reactive level 2 deep cervical lymph nodes are present bilaterally in addition to scattered smaller level 5 nodes bilaterally. Normal appearance of the parotid glands, and major cervical vessels.
Conclusion: Appearances are in keeping with clinical history of tonsilitis with associated inflammatory/edematous changes. No evidence of suppuration or abscess at this stage.
Case Discussion
Tonsillitis is a common presenting complaint to the emergency department. Most often it does not require imaging as part of its work-up unless there are concerns over abscess formation.