What are the differential diagnoses for kissing tonsils (tonsillar hypertrophy)?

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Last updated: April 14, 2025View editorial policy

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Differential Diagnosis for Kissing Tonsils

  • Single most likely diagnosis
    • Mononucleosis (infectious mononucleosis): This condition, caused by the Epstein-Barr virus, is characterized by fever, sore throat, and lymphadenopathy, and can lead to the appearance of "kissing tonsils" due to significant tonsillar enlargement.
  • Other Likely diagnoses
    • Tonsillitis: Bacterial or viral tonsillitis can cause significant swelling of the tonsils, potentially leading to a "kissing" appearance.
    • Quinsy (peritonsillar abscess): Although more commonly associated with unilateral swelling, a large peritonsillar abscess could potentially cause the tonsils to appear as if they are "kissing".
    • Lymphoma: Both Hodgkin and non-Hodgkin lymphoma can involve the tonsils and cause significant enlargement.
  • Do Not Miss diagnoses
    • Airway obstruction: Any condition causing significant tonsillar enlargement can potentially lead to airway obstruction, which is a medical emergency.
    • Abscess or cellulitis complicating tonsillitis: These conditions can lead to severe complications, including airway obstruction, sepsis, and abscess rupture.
  • Rare diagnoses
    • Angioedema: A rare condition characterized by rapid swelling of the dermis, subcutaneous tissue, mucosa, and submucosal tissues, which can cause significant airway compromise.
    • Cystic hygroma or other congenital anomalies: Although rare, these conditions can cause significant swelling in the neck and potentially affect the tonsils.
    • Sarcoidosis: A systemic granulomatous disease that can involve the lymph nodes and potentially cause tonsillar enlargement.

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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