Exactly What the Patient Said

​"I have tonsillitis," claimed the 20-something young woman who showed up at 2:30 a.m. because the pain was keeping her awake. She pointed dead midline between her chin and hyoid bone when asked the location of the pain. The back of her throat looks normal: uvula midline, no exudates, no vesicles, normal voice, and handling secretions. But the midline.... Should I be worried? The epiglottis sits right there. Before the Hib vaccine, it used to be almost all kids, but these days adults get epiglottitis. What to do? Soft tissue lateral neck? CT? Discharge?​I went with a soft tissue lateral neck, which was not at all reassuring.The epiglottis always bisects the hyoid bone in the anterior portion of the airway. It is usually somewhat parallel to base of the tongue with a strip of air into the vallecula. No such entity is distinctly visualized, so on to CT.​And the donut of truth made everything clear. The crisp, thin epiglottis can be seen pushed posteriorly by a rounded mass at the base of the tongue. The patient was right. She had tonsillitis! The radiologist concurred. It's always nice when the radiographs are in line with the anatomic drawing.​Image by Bruce Blaus. http://blausen.com. WikiJournal of Medicine 1, 2014; DOI:10.15347/wjm/2014.010. ISSN 2002-4436.Tip to Remember: It isn't only the palatine tonsils that can become infected and swollen. Lingular tonsillitis occurs at the base of the tongue and cannot be seen on routine visual ins...
Source: Lions and Tigers and Bears - Category: Emergency Medicine Tags: Blog Posts Source Type: blogs