Peritonsillar abscess differential diagnosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Prince Tano Djan, BSc, MBChB [2]
Overview
Differential diagnosis
Peritonsillar abscess must be differentiated from other upper respiratory diseases and conditions that may cause throat pain and airway obstruction as shown in the table below:
| Disease/Variable | Presentation | Causes | Physical exams findings | Age commonly affected | Imaging finding | Treatment |
|---|---|---|---|---|---|---|
| Peritonsillar abscess | Severe sore throat, otalgia fever, a "hot potato" or muffled voice, drooling, and trismus[1] | Aerobic and anaerobic | Contralateral deflection of the uvula,
the tonsil is displaced inferiorly and medially, tender submandibular and anterior cervical lymph nodes, tonsillar hypertrophy with likely peritonsillar edema. |
The highest occurrence is in adults between 20 to 40 years of age.[1] | On ultrasound peritonsillar abscess appears as focal irregularly marginated hypoechoic area.[6][7][8][9][6][7] | Ampicillin-sulbactam, Clindamycin, Vancomycin or Linezolid |
| Croup | Has cough and stridor but no drooling. Others are Hoarseness, Difficulty breathing, symptoms of the common cold, Runny nose, Fever | Parainfluenza virus | Suprasternal and intercostal indrawing,[10] Inspiratory stridor[11], expiratory wheezing,[11] Sternal wall retractions[12] | Mainly 6 months and 3 years old
rarely, adolescents and adults[13] |
Steeple sign on neck X-ray | Dexamethasone and nebulised epinephrine |
| Epiglottitis | Has stridor and drooling but no cough. Other symptoms include difficulty breathing, fever, chills, difficulty swallowing, hoarseness of voice | H. influenza type b, | Cyanosis, Cervical lymphadenopathy, Inflammed epiglottis | Used to be mostly found in
pediatric age group between 3 to 5 years, however, recent trend favors adults as most commonly affected individuals[14] with a mean age of 44.94 years |
Thumbprint sign on neck x-ray | Airway maintenance, parenteral Cefotaxime or Ceftriaxone in combination with Vancomycin. Adjuvant therapy includes corticosteroids and racemic Epinephrine.[15][16] |
| Pharyngitis | Sore throat, pain on swallowing, fever, headache, abdominal pain, nausea and vomiting | Group A beta-hemolytic | Inflammed pharynx with or without exudate | Mostly in children and young adults,
with 50% of cases identified between the ages of 5 to 24 years.[17] |
_ | Antimicrobial therapy mainly penicillin-based and analgesics. |
| Tonsilitis | Sore throat, pain on swallowing, fever, headache, cough | Most common cause is
viral including adenovirus, coronavirus, and Second most common causes are bacterial; |
Fever, especially 100°F or higher.[19][20]Erythema, edema and Exudate of the tonsils.[21] cervical lymphadenopathy, Dysphonia.[22] | Primarily affects children
between 5 and 15 years old.[23] |
Intraoral or transcutaneous USG may show an abscess making CT scan unnecessary.[24][25][26] | Antimicrobial therapy mainly penicillin-based and analgesics with tonsilectomy in selected cases. |
| Retropharyngeal abscess | Neck pain, stiff neck, torticollis | Polymicrobial infection.
Mostly; Streptococcus pyogenes, Staphylococcus aureus and respiratory anaerobes (example; Fusobacteria, Prevotella, |
Child may be unable to open the mouth widely. May have enlarged
cervical lymph nodes and neck mass. |
Mostly between 2-4 years, but can occur in other age groups.[32][33] | On CT scan, a mass impinging on the posterior pharyngeal wall with rim enhancement is seen[34][35] | Immediate surgical drainage and antimicrobial therapy. emperic therapy involves; ampicillin-sulbactam or clindamycin. |