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Tonsil ultrasound: technical approach and spectrum of pediatric peritonsillar infections

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Abstract

Peritonsillar infections are one of the most common deep neck space infections, particularly in adolescents. Inaccurate diagnosis can lead to delay in management and potentially life-threatening complications. Contrast-enhanced computed tomography (CT) scan of the neck traditionally has been used to diagnose suspected peritonsillar abscess. With growing concern over radiation exposure, there has been increasing utilization of ultrasound (US) using intraoral and transcutaneous approaches. We chose the transcutaneous US technique due to its ease of performance in children. The purpose of this article is twofold: a) to describe our technique of performing transcutaneous US of the tonsil showing sonographic appearance of normal tonsil, highlighting pertinent anatomy and unique considerations for this modality in children, and b) to illustrate the sonographic findings in the spectrum of pediatric peritonsillar infections, which includes uncomplicated tonsillitis, peritonsillar cellulitis, small intratonsillar abscess and frank peritonsillar abscess. Parapharyngeal abscess can sometimes be detected.

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Acknowledgments

We would like to express our sincere appreciation to our stellar sonographers - Cathy Brown Jones, Tara Cielma, Amanda George, Pamela Handelman, Megan Hartman, Danyelle Holley, Suella Jones, Kadine Linden, Linda Rebolo, Courtney Ruiz and Roza Zenelaj, for their expertise and insight. We are grateful to Dr. Asif Momin for his scientific guidance. We also thank Drs. Anna Blask and Eglal Shalaby-Rana for their critical comments.

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Authors and Affiliations

  1. Division of Diagnostic Imaging and Radiology, Children’s National Health System, Washington, DC, USA

    Anjum N. Bandarkar & Adebunmi O. Adeyiga

  2. Department of Otolaryngology, Children’s Hospital of San Antonio, San Antonio, TX, USA

    M. Taylor Fordham

  3. Department of Pediatric Otolaryngology, Children’s National Health System, Washington, DC, USA

    Diego Preciado & Brian K. Reilly

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  1. Anjum N. Bandarkar
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  2. Adebunmi O. Adeyiga
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  3. M. Taylor Fordham
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  4. Diego Preciado
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  5. Brian K. Reilly
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Correspondence to Anjum N. Bandarkar.

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Bandarkar, A.N., Adeyiga, A.O., Fordham, M.T. et al. Tonsil ultrasound: technical approach and spectrum of pediatric peritonsillar infections. Pediatr Radiol 46, 1059–1067 (2016). https://doi.org/10.1007/s00247-015-3505-7

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  • DOI: https://doi.org/10.1007/s00247-015-3505-7

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