Submandibular approach for para tonsillar abscess (PTA)
assessment by POCUS
Amir Mahmood, Gemma Hirons, Amber Bristow, Dr. Himanshu Gul Mirani
Nottingham University Hospitals, NHS Trust
Case Presentation:
Case 1:
32-year-old female, with history of recurrent tonsillitis, presented with complaints of sore throat. Clinically she seemed to have left para tonsillar abscess. Point of care ultrasound was used assess if the patient had tonsillar cellulitis vs tonsillar abscess, amenable to aspiration. Also, POCUS could guide about the adjacent vasculature to avoid. POCUS demonstrated a 2.76 x 2.11 cm abscess cavity which was approximately 0.6 cm away from the carotid.
CASE 1: Image of carotid vasculature and para tonsillar abscess.
CASE 2: Image of carotid vasculature and para-tonsillar abscess.
Management and Outcome:
Case 2:
25-year-old male with 2 failed attempts at
drainage of quinsy presented to the ED again
with worsening throat pain. POCUS
demonstrated para-tonsilar abscess and its
distance from the carotid vasculature.
Key Learnings and Points:
Traditionally endocavitary probe has been used to assess for PTA and its drainage.
Submandibular approach provides an alternate way to assess if there is a surgical target or not. It also allows assessment of the nearby vascular structures to avoid while aspirating.
Unlike endocavitary probe, this method has the advantage of real time ultrasound guided aspiration of the abscess, which is otherwise attempted as a blind procedure with inherent risk of carotid puncture.