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The Speed ​​of Sound: PTA: Ultrasound for Victory : Emergency Medicine News

intra-oral ultrasound, peritonsillar abscess, diagnosis:

Peritonsillar abscess as visualized by intraoral ultrasound.


A 25-year-old man presented with worsening sore throat and fever. His voice sounded like he had just taken a bite of a hot potato. His posterior pharynx reveals erythema and swelling on the left, with deviation of the uvula to the right. What is your next action? CT? Ultrasound? Just empty it? Consult your ENT friend?

Ultrasound has been described as a method of identifying a peritonsillar abscess (PTA) since the mid-1990s, primarily using an intraoral approach. Given this history, does ultrasound really pay off when it counts? Does it reduce the length of stay in the emergency department and the use of scanners and ENT consultations? Does it increase the chance of drainage success?

Constantino et al. examined some of these questions in 2012. (Acad Emergency Med. 2012;19[6]:626; They divided patients with signs and symptoms of PTA into one group to attempt landmark-guided drainage and another for intraoral ultrasound to determine if a pocket of pus was present and to guide the drainage.

They found seemingly impressive results, with ultrasound-guided treatment resulting in successful drainage 100% of the time versus 50% with the landmark approach. The ultrasound group also required fewer ENT consultations (7% of patients versus 50%) and scans (0 versus 35%).

Some of the same researchers have recently sought to compare the 2012 results to a more recent period. (J Med Urgent. 2020;59[5]:693.) They found that the use of ultrasound increased and resulted in more successful aspirations, a reduced rate of CT and ENT visits, and shorter lengths of stay.

It’s really a two-pronged problem: we need to identify the pus and successfully drain it. Ultrasound in the hands of anyone with a bit of experience is almost always better than nothing. And seeing the pus is always better than an educated guess that it’s there, and you certainly don’t need a CT to accomplish that.

The second problem is draining the pus and knowing where to put your needle or scalpel. It makes sense that ultrasound would be helpful here, especially over CT scans, because you can directly guide your procedure. These studies give the impression that the more we use ultrasound, the better we get. Practice makes almost perfect in this case.

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Dr. Buttsis Director of the Division of Emergency Ultrasound and Clinical Associate Professor of Emergency Medicine at Louisiana State University in New Orleans. Follow her on Twitter@EMNSpeedofSound, and read its past columns at