Ultrasound Case of the Week
Ultrasound for PTA by Dr. Shpilko
The Case: 28yo female with sore throat, painful swallowing, and fevers and chills. Physical exam reveals tachycardia, muffled voice, and the shown oropharynx exam.
Diagnosis: Peritonsilar abscess.
ED Course: ENT was called, bedside aspiration was performed, patient was placed on antibiotics and discharged home.
Bedside US for PTAs:
Technique: transcutaneous approach (because intraoral is not available nor comfortable):
I. Linear or curvilinear probe: place just under the angle of the mandible with marker towards patients ear.
II. Direct transducer posterosuperiorly toward the tonsillar fossa
III. Fan cephalad from carotid and internal jugular vein. Color doppler may help differentiate from vascular structures.
IV. Compare with normal contralateral side.
Transcutanous also allows for u/s guided aspiration as it is difficult to fit both the intraoral probe and your needle in the mouth at the same time to guide drainage in real time.