Image Based Question-66164

A patient presented with severe pain in the throat(more on left side),high grade fever,muffled voice and painful swallowing.On examination of the throat,the following picture is seen.What is the most probable diagnosis?

A. Retropharyngeal Abscess.

B. Parapharyngeal Abscess.

C. Peritonsillar Abscess.

D. Acute Tonsillitis.

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Correct Answer » C Explanation

Ans;C. Peritonsillar Abscess

QUINSY(PERITONSILLAR ABSCESS)

• Quinsy consists of suppuration outside the tonsil capsule .

• There is collection of pus between the capsule of tonsil and the superior constrictor muscle, i.e. in the peritonsillar area.

• Peritonsillar abscess is a complication of tonsillitis and is most commonly caused by group A beta – hemolytic streptococcus.

CLINICAL FEATURES :

1. General : They are due to septicaemia and resemble any acute infection. They include fever (up to 104°F), chills and rigors, general malaise, body aches, headache, nausea and constipation.

Local :

1. Severe pain in throat. Usually unilateral.
2. Odynophagia. It is so marked that the patient cannot even swallow his own saliva which dribbles from the angle of his mouth. Patient is usually dehydrated.
3. Muffled and thick speech, often called “Hot potato voice”.
4. Foul breath due to sepsis in the oral cavity and poor hygiene.
5. Ipsilateral earache. This is referred pain via CN IX which supplies both the tonsil and the ear.
6. Trismus due to spasm of pterygoid muscles which are in close proximity to the superior constrictor.

EXAMINATION FINDINGS :

1. The tonsil, pillars and soft palate on the involved side are congested and swollen. Tonsil itself may not appear enlarged as it gets buried in the oedematous pillars.
2. Uvula is swollen and oedematous and pushed to the opposite side.
3. Bulging of the soft palate and anterior pillar above the tonsil.
4. Mucopus may be seen covering the tonsillar region.
5. Cervical lymphadenopathy is commonly seen. This involves jugulodigastric lymph nodes.
6. Torticollis : Patient keeps the neck tilted to the side of abscess.

TREATMENT :

• IV fluids

• Antibiotics : High dose penicllin. (iv benzipenicillin) is the DOC. In patients allergic to penicillin erythromycin is the DOC.

• Incision and drainage per orally, if the abscess does not resolve depite high dose of iv antibiotics in 48 hours.

• Tonsillectomy is done 6-8 weeks following an attack of quinsy (interval tonsillectomy).