Study of CT Findings and Clinical Courses of Peritonsillar Abscesses

Abstract

Treatments of peritonsillar abscesses (PTAs) include observation with antibiotics, drainage by needle aspiration or incision, and quinsy tonsillectomy. Inadequately treated infections may have lethal complications like deep neck abscesses or mediastinitis. We reviewed 100 patients diagnosed as having PTAs on the basis of computed tomography (CT) findings between January 2013 and April 2016. The longest diameter of a PTA on axial view of enhanced CT using a contrast agent was measured. The PTA with the longest diameter located cranial to the palatine uvula was defined as a superior type, and the PTA with the longest diameter located caudally was defined as an inferior type. The longest diameters, presence of laryngeal edema, treatments, and treatment periods were investigated. Although the superior type had a longer diameter, the inferior type had laryngeal edema more frequently. Diameters of abscesses treated by observation with antibiotics were all shorter than 16 mm, and significantly shorter than those of abscesses treated by drainage or quinsy tonsillectomy. Drainage by needle aspiration or incision was selected mostly for the superior type, since the pus was drained sufficiently and the treatment period was shorter in this treatment compared to quinsy tonsillectomy. Quinsy tonsillectomy was selected more for the inferior type with large abscesses, since it could achieve complete drainage and prevent recurrence in almost the same treatment period as cases treated by aspiration or incision.