Transoral Point-of-Care Ultrasound in the Diagnosis of Parapharyngeal Space Abscess.

Authors:
Steve Socransky
Steve Socransky
Northern Ontario School of Medicine
Jordan Chenkin
Jordan Chenkin
University of Toronto

J Emerg Med 2019 Jan 1;56(1):70-73. Epub 2018 Nov 1.

Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada.

Background: Parapharyngeal space abscesses (PPSA) are deep-space neck infections that are associated with significant morbidity and, rarely, mortality if not promptly diagnosed and treated. The diagnosis is often difficult, as the clinical presentation can mimic peritonsillar abscesses (PTA). Transoral point-of-care ultrasound (POCUS) may be a useful tool to help distinguish PTAs from other deep-space infections such as PPSAs.

Case Report: A woman presented to the Emergency Department (ED) with fever, sore throat, trismus, and unilateral tonsillar swelling from a walk-in clinic with a preliminary diagnosis of PTA for drainage. A POCUS performed by the emergency medicine resident in the ED demonstrated normal tonsils. However, it revealed evidence of a PPSA. A computed tomography scan was performed, which confirmed the diagnosis. The patient was admitted to the otolaryngology service for antibiotics and steroids, with subsequent improvement and discharge home. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: In this case, the use of POCUS in the ED avoided an unnecessary invasive procedure, and facilitated the correct diagnosis of an uncommon condition.

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Source
https://linkinghub.elsevier.com/retrieve/pii/S07364679183095
Publisher Site
http://dx.doi.org/10.1016/j.jemermed.2018.09.034DOI Listing
January 2019
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