1. PATIENT PRESENTATION
A healthy 58‐year‐old man presented to the emergency department with a sore throat, odynophagia, and dyspnea. He was afebrile and his oxygen saturation was 96% in ambient air. Physical examination revealed enlarged tonsils on the left with a shift of the uvula to the right and mild trismus but no drooling. A peritonsillar abscess was suspected, and computed tomography (CT) examination was planned. However, when the patient was placed in the supine position, his dyspnea worsened and drooling appeared. We performed contrast‐enhanced CT while preparing to manage the airway obstruction (Figure 1).
FIGURE 1.
Contrast‐enhanced computed tomography of the neck showed a left‐sided peritonsillar abscess (white arrow) with diffuse edema of the epiglottis (red arrow)
2. DIAGNOSIS: PERITONSILLAR ABSCESS CONCURRENT WITH EPIGLOTTIS
Peritonsillar abscess concurrent with epiglottitis was diagnosed. Laryngoscopy was performed by an otolaryngologist and revealed an erythematous epiglottis with swelling (Figure 2). Ampicillin sulbactam and hydrocortisone were administered immediately. Tracheostomy was performed by an otolaryngologist in the operating room. The blood cultures were negative. The clinical symptoms improved, and the tracheostomy tube was removed after 2 weeks of treatment with intravenous antibiotics. He was discharged uneventfully.
FIGURE 2.
Laryngoscopy revealed an erythematous epiglottis with swelling (white arrow) and the wall of a peritonsillar abscess (black arrow)
Acute epiglottitis complicated by peritonsillar abscess is uncommon but not rare. It was identified in 21 of 139 cases (15%) in 1 retrospective review. 1 In a separate case series, CT scanning was considered to be safe and diagnostically effective. 2 On the other hand, because CT scanning is performed in the supine position, the risk of airway obstruction may increase in patients with acute epiglottitis. 3 Although CT scanning is often performed for diagnosis of peritonsillar abscess, physicians should be alert to the appearance of airway obstruction due to concomitant acute epiglottitis.
Okumura H, Takebe K. Male with sore throat and Dyspnea. JACEP Open. 2022;3:e12686. 10.1002/emp2.12686
The manuscript has not been published or presented elsewhere in part or its entirety.
Patient consents for these photographs to be used in medical publications, including medical journals.
REFERENCES
- 1. Ohori J, Miyashita K, Harada M, et al. Unilateral arytenoid swelling in acute epiglottitis suggests the presence of peritonsillar abscess. Auris Nasus Larynx. 2020;47:1023‐1026. [DOI] [PubMed] [Google Scholar]
- 2. Ito K, Chitose H, Koganemaru M. Four cases of acute epiglottitis with a peritonsillar abscess. Auris Nasus Larynx. 2011;38:284‐288. [DOI] [PubMed] [Google Scholar]
- 3. Lee SH, Yun SJ, Kim DH, et al. Do we need a change in ED diagnostic strategy for adult acute epiglottitis?. Am J Emerg Med. 2017;35:1519‐1524. [DOI] [PubMed] [Google Scholar]