Unilateral arytenoid swelling in acute epiglottitis suggests the presence of peritonsillar abscess.

OBJECTIVE: To investigate the incidence of acute epiglottitis (AE) and the clinical features of patients with AE complicated by peritonsillar abscess (PTA), considering that PTA, especially inferior-type PTA, is often a comorbidity of AE. METHODS: We retrospectively reviewed the medical records of patients who were diagnosed as having AE by otolaryngologists and referred to our hospital between January 2009 and December 2017. All the patients underwent laryngeal endoscopy and contrast-enhanced computed tomography (CT) for examination of the severity of AE and its complications by other infections, including PTA. The clinical characteristics of patients with PTA were compared with those of patients without PTA. RESULTS: A total of 139 patients were enrolled, of whom 21 (15%) were found to have PTA. Among the 21 patients, only one had a superior-type PTA and the others had an inferior-type PTA. The patients with complicated AE by an inferior Cap-type PTA frequently showed unilateral arytenoid swelling. CONCLUSION: PTA is a comorbidity of AE, and unilateral arytenoid swelling is considered to suggest the presence of inferior-type PTA.

Clinical classification of peritonsillar abscess based on CT and indications for immediate abscess tonsillectomy.

OBJECTIVE: To clarify indications for immediate abscess tonsillectomy (IAT) for peritonsillar abscess (PTA). METHODS: A retrospective study was performed on 99 patients who were diagnosed with PTA on the basis of computed tomography (CT). Based on CT findings, PTA patients were classified into two categories by abscess shape: Oval type and Cap type. Furthermore, abscess location was differentiated into superior and inferior, resulting in a final classification of 4 categories: superior Oval type; superior Cap type; inferior Oval type; and inferior Cap type. In addition, the proportion of PTA patients showing extraperitonsillar spread into parapharyngeal spaces in each category was examined. RESULTS: Superior Oval-type PTA was the most common. Thirteen patients showed extraperitonsillar spread. When CT classifications were compared with clinical findings, patients with inferior Cap-type abscess displayed extraperitonsillar spread more frequently than the other categories of PTA. In all 13 patients, the parapharyngeal space was involved. In addition, 3 patients displayed retropharyngeal space involvement. In all 13 cases, abscess remained above the hyoid bone. CONCLUSIONS: Inferior Cap-type PTA may need more intensive and reliable treatment, such as IAT, which might be effective for PTA showing extraperitonsillar spread.

[Computed tomography image analysis of peritonsillar abscess].

The peritonsillar abscess (PTA) is one of the most common infectious diseases in the head and neck area and is treated with puncture, incision, or abscess tonsillectomy. In the present study, we performed a retrospective study for the patients who were diagnosed as having PTA on the basis of CT findings at the Kagoshima University Hospital between January 2007 and April 2012. The clinical characteristics were compared with the CT images and the indication of abscess tonsillectomy was discussed. In total, 145 patients (152 sides), mean age of 41 years (range: 5-80 years) were enrolled in the study. Patients having any surgical treatment such as puncture and incision before visiting our hospital were excluded. The CT findings revealed that PTA could be classified into two categories by the shapes of the abscess: the Oval type and Cap type. Further, the location of the abscess was differentiated superior and inferior, and classified into 4 categories: superior Oval type, superior Cap type, inferior Oval type, and inferior Cap type. The results showed that the number of the superior Oval type PTA was largest and followed by superior Cap type, inferior Cap type, and inferior Oval type in this order. When the CT classifications were compared with clinical findings, patients with the inferior Cap type abscess had laryngeal edema and airway obstruction more frequently than the other categories of PTA. Histological examination of the specimens obtained during surgery showed that the Cap type abscess tended to include more muscular tissue compared to the Oval type, indicating that inflammation might be more severe and wider in the Cap type than the Oval type. Those findings suggest that the inferior Cap type of PTAs need more intensive and reliable treatments such as abscess tonsillectomy.

Two cases of peritonsillar abscess complicated by von Willebrand disease.

Von Willebrand disease (vWD) is a common hereditary bleeding disorder resulting from a quantitative and/or qualitative deficiency of von Willebrand factor (vWF). We report two cases of peritonsillar abscess complicated by vWD. A 46-year-old Japanese man was intravenously administered factor VIII clotting antigen (500U×3 days)and platelet transfusion (10U), when before puncture was performed. After puncture, his symptoms promptly improved with the administration of the antibiotic doripenem (DRPM, 1.5g/day). He left our facility one week later and had no recurrence of symptoms. A 24-year-old Japanese woman was intravenously administered factor VIII clotting antigen (4500U×3 days) and desmopressin (DDAVP) before undergoing a puncture. Her symptoms promptly improved with DRPM treatment (1.5g/day). The patient left our facility one week later. However, the peritonsillar abscess recurred in three weeks. Afterwards, tonsillectomy was enforced three months later. Intravenous factor VIII clotting antigen (4500U×2 days) and platelet transfusion (10U×1 day) had been used before tonsillectomy. We therefore suggest that a peritonsillar abscess in patients with vWD can be safely treated by factor VIII clotting antigen and DDAVP at the appropriate disease stage and by performing paracentesis for the acute phase or tonsillectomy for the chronic phase.

Necrotizing sialometaplasia of the parotid gland associated with angiocentric T-cell lymphoma: a case report and review of the literature.

A very rare case of necrotizing sialometaplasia of the parotid gland associated with angiocentric T-cell lymphoma was described. A 66-year-old male had left neck and pharyngeal masses and biopsy specimen showed a monotonous proliferation of atypical lymphoid cells with massive necrosis in the parotid gland. Angiocentric pattern or vascular invasion by the lymphoid cells was observed and the involved parotid gland exhibited squamous metaplasia of the ducts and acini; necrotizing sialometaplasia. Immunohistochemical analysis revealed a cytotoxic T-cell phenotype of the lymphoid cells (CD3+, CD4-, CD5+, CD8+, CD56-, Granzyme B+, TIA-1+, Perforin-) but in situ hybridization showed no relation to Epstein-Barr virus. Although necrotizing sialometaplasia is relatively rare in the parotid gland, angiocentric T-cell lymphoma should be considered for a causative condition of necrotizing sialometaplasia.