1/Is the never ending debate on tonsillitis becoming hard to swallow?
Tonsillar or peritonsillar abscess? That is the question!
When you look at a neck CT, do YOU know which one to say?
A thread on tonsillitis and its complications!
Tonsillar or peritonsillar abscess? That is the question!
When you look at a neck CT, do YOU know which one to say?
A thread on tonsillitis and its complications!
2/First some anatomy.
Palatine tonsils (or faucial to the cool kids) sit in the oropharynx between two arches:
(1) palatoglossus arch in front
(2) the palatopharyngeus arch in back.
These are easily visible on physical exam.
Palatine tonsils (or faucial to the cool kids) sit in the oropharynx between two arches:
(1) palatoglossus arch in front
(2) the palatopharyngeus arch in back.
These are easily visible on physical exam.
3/These archs are actually just mucosa draped over the palatoglossus and palatopharygeus musculature, like kids drape sheets over themselves to dress up for Halloween.
4/The palatine tonsils sit nestled in between these two arches in a space called the tonsillar fossa.
The pillars are like the bed and blankets the tonsils are tucked in between
The pillars are like the bed and blankets the tonsils are tucked in between
5/Tonsils are made up triangular folds & crevices in between, called crypts.
This anatomy increases tonsillar surface area to expose it to as many of the oropharyngeal antigens as possible.
Just below the surface are many lymph node germinal centers to examine the antigens
This anatomy increases tonsillar surface area to expose it to as many of the oropharyngeal antigens as possible.
Just below the surface are many lymph node germinal centers to examine the antigens
6/The lymphatic channels from these germinal centers are valveless (in adultsāI donāt do kids š).
This allows for immediate transport of antigens--like a freeway w/o lights
This makes sense, as you want to be aware of any bad antigen entering your oropharynx ASAP
This allows for immediate transport of antigens--like a freeway w/o lights
This makes sense, as you want to be aware of any bad antigen entering your oropharynx ASAP
7/Tonsillitis occurs when there is an infection of the tonsils, usually strep pneumo.
Inflammatory debris is made in the crypts and excreted out, creating the white patches seen on physical exam
Inflammatory debris is made in the crypts and excreted out, creating the white patches seen on physical exam
8/On CT, this inflammatory changes causes enlargement of the tonsils and hyperenhancement of the crypts.
This results in the classic "tiger-stripe" appearance of tonsillitis.
This results in the classic "tiger-stripe" appearance of tonsillitis.
9/An abscess occurs when one of these crypts gets obstructed--like putting a cork in it!
Then its inflammatory exudate turns into pus under pressure.
Then its inflammatory exudate turns into pus under pressure.
10/But the pus doesnāt stay in the tonsil.
Itās under pressure, like a volcano.
If itās plugged, the lava will find a way out b/c of the pressure
Lava will flow out any cracks/pores in the rock
In the tonsil, pores are the valveless lymphatics that allow the pus to flow out
Itās under pressure, like a volcano.
If itās plugged, the lava will find a way out b/c of the pressure
Lava will flow out any cracks/pores in the rock
In the tonsil, pores are the valveless lymphatics that allow the pus to flow out
11/Trying to keep the pus in the tonsil is like trying to keep water in a bathtub when the drain is open. It will always pour out.
Similarly, in adults, the pus never stays in the tonsilāit pours out the valveless lymphatics into the tonsillar fossa/peritonsillar space.
Similarly, in adults, the pus never stays in the tonsilāit pours out the valveless lymphatics into the tonsillar fossa/peritonsillar space.
12/Once the pus is in the tonsillar fossa, it becomes a peritonsillar abscess.
It does not have to go through the superior constrictor musculature to be considered a peritonsillar abscess
It does not have to go through the superior constrictor musculature to be considered a peritonsillar abscess
13/So the answer to the question āTonsillar or peritonsillar abscess?ā is the same answer my kid knows to give when asked, āWhich parent do you love the most?ā The answer: both!
Hopefully, this thread will clear your throat confusion!
Hopefully, this thread will clear your throat confusion!
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