Which statement is true regarding imaging in suspected peritonsillar abscess?

Which statement is true regarding imaging in suspected peritonsillar abscess?

• A. Ultrasound is the preferred modality for differentiating cellulitis from abscess.
• B. CT scan of the head and neck is preferred for differentiating cellulitis from abscess.
• C. MRI is never useful here.
• D. Plain X-ray is sufficient.

Answer: (B)

Imaging in suspected peritonsillar abscess aims to distinguish a true abscess from cellulitis and to map the extent of infection for treatment planning. The preferred study is a CT scan of the head and neck with IV contrast because it provides rapid, detailed cross-sectional images that clearly differentiate a discrete fluid collection with rim enhancement (abscess) from diffuse tissue swelling without a focal collection (cellulitis). It also shows involvement of adjacent deep neck spaces and helps guide decisions about drainage and airway risk. Ultrasound can sometimes help at the bedside, particularly in children or when access to CT is limited, and it may detect a superficial collection. However, it has limited reliability for deep peritonsillar structures and depends on the operator, so it is not the definitive test for differentiating abscess from cellulitis. Plain X-ray is not useful for this purpose, and MRI, while sensitive, is impractical in acute care due to time and availability constraints, so it is not the first-line choice here.

Imaging in suspected peritonsillar abscess aims to distinguish a true abscess from cellulitis and to map the extent of infection for treatment planning. The preferred study is a CT scan of the head and neck with IV contrast because it provides rapid, detailed cross-sectional images that clearly differentiate a discrete fluid collection with rim enhancement (abscess) from diffuse tissue swelling without a focal collection (cellulitis). It also shows involvement of adjacent deep neck spaces and helps guide decisions about drainage and airway risk.

Ultrasound can sometimes help at the bedside, particularly in children or when access to CT is limited, and it may detect a superficial collection. However, it has limited reliability for deep peritonsillar structures and depends on the operator, so it is not the definitive test for differentiating abscess from cellulitis. Plain X-ray is not useful for this purpose, and MRI, while sensitive, is impractical in acute care due to time and availability constraints, so it is not the first-line choice here.