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 visualization 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 visualization examination. Microbiology assay positive for Corynebacterium diphtheriae.
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