Differentials
Peritonsillar abscess
SIGNS / SYMPTOMS
Bulging peritonsillar mucosa with marked unilateral tonsillar displacement and concomitant uvular deviation.
INVESTIGATIONS
CT may show a hypodense fluid collection with rim enhancement.
Tonsillitis
SIGNS / SYMPTOMS
Erythema of tonsils.
INVESTIGATIONS
Lateral neck radiograph will be normal.
Foreign body aspiration
SIGNS / SYMPTOMS
There may be no difference in signs and symptoms. Usually, the health professional may be able to elicit a history of a potential foreign-body aspiration.
INVESTIGATIONS
Foreign body seen on imaging studies. Radiolucent objects may be missed. If suspicious of an aspirated foreign body, direct laryngoscopy and bronchoscopy is imperative.
Retropharyngeal abscess
SIGNS / SYMPTOMS
This cannot be accurately differentiated by symptomatology or physical examination findings, which can be highly variable. All the spaces in the neck are interconnected; hence a severe infection in one fascial plane can lead to infection in other planes.
INVESTIGATIONS
Lateral neck radiograph: may see a bulge of the retropharyngeal space on a lateral neck radiograph.
CT scanning will demonstrate a retropharyngeal abscess.
Direct visualisation by laryngoscopy may show bulging of the retropharyngeal space and the absence of epiglottitis.
Croup (laryngotracheobronchitis)
SIGNS / SYMPTOMS
A barky cough suggests croup.
INVESTIGATIONS
Anteroposterior neck radiograph will reveal classically appearing steeple sign of the subglottis.
Diphtheria
SIGNS / SYMPTOMS
Pharyngeal membranes with diphtheria.
INVESTIGATIONS
Direct visualisation examination. Microbiology assay positive for Corynebacterium diphtheriae.
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