Pediatric Peritonsillar Abscess Workup

  • Author: Itzhak Brook, MD, MSc; Chief Editor: Russell W Steele, MD   more...
 
Updated: Mar 8, 2012
 

Laboratory Studies

Laboratory tests are unnecessary if the diagnosis of peritonsillar abscess (PTA) is straightforward. However, tests may include the following:

Obtain a CBC count with differential. CBC may show a leukocytosis with neutrophil predominance. With infectious mononucleosis, expect lymphocyte predominance with atypical lymphocytosis.

Obtain serum electrolyte levels if the patient's oral intake has declined.

Purulent material from needle aspiration should be obtained for Gram stain and culture and sensitivity for aerobic and anaerobic bacteria. Some experts believe this is unnecessary because almost all patients respond following drainage and antibiotic therapy, regardless of culture results. Identifying the organisms and determining their antimicrobial susceptibility are helpful in guiding antimicrobial therapy especially in the presence of complications or extension of infection and in immunocompromised patients. If testing is desired, send material for both aerobic and anaerobic bacteria in appropriate transport media and not on swabs. Culture may be sterile if the patient is currently taking antibiotics.

Obtain blood cultures for aerobic and anaerobic bacteria.

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Imaging Studies

Imaging studies are unnecessary if the diagnosis is straightforward.

CT scan with intravenous contrast is the preferred radiological study (see the image below).[17, 18]

CT scan with contrast demonstrates a 2-cm low-atteCT scan with contrast demonstrates a 2-cm low-attenuation mass with a minimally enhancing wall in the right peritonsillar region. Associated edema, ipsilateral jugulodigastric lymphadenopathy, compression of the internal jugular vein, and deviation of the airway are present.

This study is indicated when the diagnosis is unclear, when the patient is uncooperative with the examination, and when the infectious process is thought to involve deeper structures. An abscess appears as a low-attenuation mass with a ring-enhancing wall. Presence of only loss of the fat planes, lack of ring enhancement and soft tissue swelling and edema (but no mass) are consistent with peritonsillar cellulitis.

Ultrasonography is indicated for differentiating between peritonsillitis and peritonsillar abscess.[15, 18] The intraoral approach is more accurate than the transcutaneous approach. However, this approach may be limited by the presence of trismus. Peritonsillar cellulitis manifests a homogeneous or striated area with no distinct fluid collection. Peritonsillar abscess appears as an echo-free cavity with an irregular border. Ultrasonography has a reported sensitivity of 89% and specificity of 100%.

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Contributor Information and Disclosures
Author

Itzhak Brook, MD, MSc  Professor, Department of Pediatrics, Georgetown University School of Medicine

Itzhak Brook, MD, MSc is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians-American Society of Internal Medicine, American Federation for Clinical Research, American Medical Association, American Society for Microbiology, Armed Forces Infectious Diseases Society, Association of Military Surgeons of the US, Infectious Diseases Society of America, International Immunocompromised Host Society, International Society for Infectious Diseases, Medical Society of the District of Columbia, New York Academy of Sciences, Pediatric Infectious Diseases Society, Society for Ear, Nose and Throat Advances in Children, Society for Experimental Biology and Medicine, Society for Pediatric Research, Southern Medical Association, and Surgical Infection Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Ashir Kumar, MD, MBBS, FAAP  Professor Emeritus, Department of Pediatrics and Human Development, Michigan State University College of Human Medicine

Ashir Kumar, MD, MBBS, FAAP is a member of the following medical societies: American Association of Physicians of Indian Origin and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Joseph Domachowske, MD  Professor of Pediatrics, Microbiology and Immunology, Department of Pediatrics, Division of Infectious Diseases, State University of New York Upstate Medical University

Joseph Domachowske, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American Society for Microbiology, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Robert W Tolan Jr, MD  Chief, Division of Allergy, Immunology and Infectious Diseases, The Children's Hospital at Saint Peter's University Hospital; Clinical Associate Professor of Pediatrics, Drexel University College of Medicine

Robert W Tolan Jr, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, Phi Beta Kappa, and Physicians for Social Responsibility

Disclosure: Novartis Honoraria Speaking and teaching

Chief Editor

Russell W Steele, MD  Head, Division of Pediatric Infectious Diseases, Ochsner Children's Health Center; Clinical Professor, Department of Pediatrics, Tulane University School of Medicine

Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, and Southern Medical Association

Disclosure: Nothing to disclose.

Additional Contributors

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous author Gershon Segal, MD, to the development and writing of this article.

References

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Examination of the oropharynx demonstrates unilateral swelling and erythema of the left tonsil with deviation of the uvula to the contralateral side. Courtesy of Michael Altieri, MD, Medifor, Inc. Used with permission.
CT scan with contrast demonstrates a 2-cm low-attenuation mass with a minimally enhancing wall in the right peritonsillar region. Associated edema, ipsilateral jugulodigastric lymphadenopathy, compression of the internal jugular vein, and deviation of the airway are present.
 
 
 
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