{"id":899,"date":"2017-10-02T01:10:52","date_gmt":"2017-10-02T01:10:52","guid":{"rendered":"http:\/\/emultrasound.sdsc.edu\/?p=899"},"modified":"2020-07-22T00:06:25","modified_gmt":"2020-07-22T00:06:25","slug":"case-7-a-case-of-asymmetry","status":"publish","type":"post","link":"https:\/\/emultrasound.ucsd.edu\/index.php\/2017\/10\/02\/case-7-a-case-of-asymmetry\/","title":{"rendered":"Case # 7: A Case of Asymmetry"},"content":{"rendered":"
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A 22 year old male\u00a0presents to the emergency department with a sore throat for 1 week. The pain is predominately on the left side and is associated with difficulty opening his\u00a0mouth and fever. He\u00a0was placed on amoxicillin 3 days ago but notes that his\u00a0symptoms have progressed. He\u00a0appears uncomfortable.<\/p>\n

Vitals: T 101.4 HR 105\u00a0BP 132\/81\u00a0 RR 14\u00a0O2 98% on RA<\/p>\n

A bedside ultrasound is performed, what is the next best step in management?<\/p>\n<\/div>\n<\/div>\n<\/div>\n

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\"PTA\"

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Answer and Learning Point<\/h3>
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Answer<\/strong><\/p>\n

Incision and drainage. The patient presents with lateralizing pharyngitis symptoms associated with fever and trismus concerning for peritonsillar abscess (PTA). The ultrasound clip demonstrates a well circumscribed, hypoechoic fluid collection abutting the left tonsil confirming this diagnosis (see color overlay below).<\/span><\/p>\n

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Previously, physicians relied solely on the physical exam findings of peritonsillar swelling and uvular deviation to make the diagnosis of PTA. However, this approach lacks accuracy, with studies showing a sensitivity and specificity of 75% and 50% respectively [1]. This uncertainty leads to increased CT utilization, repeat drainage attempts and ENT consultation. Intraoral ultrasound is a novel technique that can be used by emergency physicians (EP), both for diagnosis and drainage of PTA. A recent randomized control trial found the use of intraoral ultrasound (vs. traditional landmark technique) to be significantly more reliable for differentiating between PTA and peritonsillar cellulitis. Additionally, this study also demonstrated increased success in PTA drainage by EPs with the use of intraoral ultrasound guidance [2].<\/span><\/p>\n

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Data from Costantino et al<\/figcaption><\/figure>\n

Learning Points<\/strong><\/p>\n