From the Research
A CT scan is recommended for peritonsillar abscess (PTA) when there are concerns about potential complications or diagnostic uncertainty, such as severe symptoms suggesting extension beyond the peritonsillar space, trismus, voice changes, dysphagia, or respiratory distress. This approach is supported by the most recent and highest quality studies, including 1, which analyzed CT images of peritonsillar abscesses and found that certain types of abscesses, such as the inferior Cap type, may require more intensive treatment due to a higher risk of complications like laryngeal edema and airway obstruction.
Indications for CT Scan in PTA
- Severe symptoms suggesting possible extension beyond the peritonsillar space
- Trismus (limited mouth opening)
- Voice changes
- Dysphagia
- Respiratory distress that seems disproportionate to a typical PTA
- Suspicion of parapharyngeal or retropharyngeal space involvement
- Clinical examination is limited due to severe trismus
- Recurrent or persistent symptoms despite appropriate treatment
- Difficulty distinguishing between peritonsillar cellulitis and abscess
Benefits of CT Scan in PTA
- Visualize the extent of the infection
- Identify potential complications like jugular vein thrombosis or carotid artery involvement
- Guide surgical drainage approaches
- Help determine the need for more intensive treatment, such as abscess tonsillectomy, as suggested by 1
Routine, Uncomplicated PTA
For routine, uncomplicated PTAs with classic presentation, CT imaging is generally unnecessary as diagnosis can be made clinically, and immediate needle aspiration or incision and drainage remains the standard treatment approach, as discussed in 2 and 3. However, the use of CT scans in these cases should be considered on a case-by-case basis, taking into account the patient's overall clinical presentation and risk factors for complications.