RU2190962C2 - Method for diagnosing paratonsillary abscesses - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves carrying out ultrasonic scanning of cervical area surface in longitudinal and transverse planes. Echographic symptom complex is determined. Rounded shape formation having white-gray line boundary, fuzzy outline of the formation and inhomogeneous contents of the cavity being found, paratonsillary abscess is considered to be diagnosed. EFFECT: high accuracy of diagnosis.

Description

 The invention relates to medicine, namely to the diagnosis of paratonsillar abscess.

 In recent years, the number of paratonsillar abscesses of any localization has increased significantly, their consequences cause not only a very extensive pathology of the internal organs, but can also lead to death.

 Despite significant successes in the treatment and prevention of chronic tonsillitis, as well as related complications, paratonsillar abscess is not a rare disease. So, according to various authors, the incidence of paratonsillar abscess, depending on geographic conditions, ranges from 1.2% to 20%, accounting for 2.6-7.5% of all people seeking ENT care.

 A paratonsillar abscess is localized in loose tissue surrounding the tonsils. With the spread of the inflammatory process beyond the palatine tonsil, an infiltrate is formed in the paratonsillar tissue, which, as the disease progresses, suppurates with the formation of an abscess.

 The clinical diagnosis of paratonsillar abscess is quite simple, but significant difficulties appear in determining the indications for opening it. Quite often, when opening a paratonsillar abscess, cavities with its pathological contents cannot be detected. A radical solution to the problem is surgery - removal of the palatine tonsil along with an abscess (abscessstonsillectomy). It has been proven that the greatest therapeutic effect is achieved precisely during abscessstonsillectomy in the "hot" period, that is, in the presence of a formed abscess in the paratonsillar region.

 A known method for the diagnosis of paratonsillar abscess M.Sakaguchi et al. in the work "Computed tomographic findings in peritonsillar abscess and cellulitis" (J. Laryngol. Otol. - 1995.- V.109.- N5. - P.449-451), in which computed tomography is proposed for the diagnosis of paratonsillar abscess.

 The disadvantages of this method are: the complexity and high cost of the study, the absence of clear signs in the stages of infiltration and abscess formation.

 A small number of works by other authors recommend ultrasound for the detection of paratonsillar abscess (synonyms - ultrasonography, ultrasound).

 The closest in technical essence is the method proposed by A. Blockmanis in the work "Ultrasound in the diagnosis and management of peritonsillar abscesses" (J. Otolaryngol.- 1994.- V.23 - N4.- P.260-262). The author recommends the use of intraoral ultrasound for the diagnosis of paratonsillar abscess.

 This method of diagnosing paratonsillar abscess was taken by us as a prototype.

 The disadvantage of this method is: the lack of clear criteria for the diagnosis of paratonsillar abscess.

 The invention is aimed at solving the problem of developing a method for the diagnosis of paratonsillar abscess.

 The solution to this problem will increase the accuracy of diagnosis of paratonsillar abscess, as well as ensure the timely conduct of therapeutic measures, by identifying clear diagnostic signs of paratonsillar abscess, adequate treatment is possible.

 To achieve this technical result, the claimed invention a method for the diagnosis of paratonsillar abscess contains the following essential features.

 By evaluating the reflected ultrasonic signals from the tissues, an ultrasound scan of the surface of the cervical region in the longitudinal and transverse planes is carried out, an echographic symptom complex is determined and, in the presence of a rounded shape with a white-gray line border, fuzzy contours of formation and heterogeneity of the contents of the cavity, paratonsillar abscess is diagnosed.

 The following causal relationship exists between the distinguishing features and the result: ultrasound scanning of the cervical region in the longitudinal and transverse planes, determination of the echographic symptom complex (the presence of the formation of a rounded shape with a border in the form of a white-gray line, as well as the fuzzy contours of the formation and heterogeneity of the contents of the cavity) allows you to diagnose a paratonsillar abscess, timely conduct therapeutic measures.

 According to the information available to the authors, the set of essential features characterizing the essence of the claimed invention is not known, which allows us to conclude that the invention meets the criterion of "novelty."

 According to the authors, the essence of the claimed invention should not be obvious to specialists from a known level of medicine, since the above-mentioned possibility of diagnosing a paratonsillar abscess does not come out of it, which allows us to conclude that the invention meets the criterion of "inventive step".

 The set of essential features characterizing the essence of the invention, in principle, can be repeatedly used in medicine to obtain a technical result consisting in the accurate and early diagnosis of paratonsillar abscess, which allows us to conclude that the invention meets the criterion of "industrial applicability".

 The proposed method is as follows.

 A more informative two-dimensional sonography method was used. The study was carried out on a Logiq 400 MD apparatus; a 7.5 MHz sensor was used for acoustic contact, which makes it easy to change the scanning plane with a small area of contact with skin. A study of the perinomindalic region was studied in the position of the patient lying on his back with his head turned in the direction opposite to the subject. The sensor was installed in the submandibular region parallel to the body of the lower jaw on the corresponding side, and then arbitrarily moved it along the side of the neck down and somewhat posteriorly. Another scanning plane was carried out when the sensor was installed parallel to the lower jaw branch, somewhat posterior to it. The movement of the ultrasound source in this case was performed up and down. The scanning angle was chosen arbitrarily, which was controlled on the monitor. Thus, the scan was performed in two mutually perpendicular planes: horizontal and sagittal. The image visualized on the screen in the form of a moving picture was stopped in a certain place using the "freeze frame" function, and then a more detailed study of the echogram was made. The image was recorded on black and white thermal contrast paper.

 The paratonsillar abscess on the screen of the cathode ray tube looked like the formation of a round or oval shape of one size or another against the background of a grayish shadow from the surrounding tissues. The internal contents of the abscess cavity were rarely completely homogeneous, more often an inhomogeneous hypoechoic shadow corresponding to a purulent discharge was observed. The border of the abscess on the echograms looked like a white-gray line corresponding to tissues with increased echogenicity. Thus, the main diagnostic feature of a paratonsillar abscess containing purulent discharge was revealed - the formation of a round or oval shape with a border in the form of a white-gray line.

 The second diagnostic sign of a paratonsillar abscess with an extremely thick purulent discharge is the fuzziness of the contours of formation and the heterogeneity of the contents of the cavity.

 As an example of using the method, we provide extracts from the medical history.

Patient S., 42 years old, medical history 361 was admitted to the ENT department of the Republican Oncology Center with complaints of severe pain in the pharynx on the left, fever up to 38.4 ^o C. From the anamnesis it became known that she was sick for 6 days. It was treated on an outpatient basis, took antibiotics inside. Since there was no improvement, she was hospitalized.

 At admission: the patient's general condition is satisfactory, from the side of internal organs pathological changes were not noted. The contours of the neck are correct. There is a trism of chewing muscles. With pharyngoscopy, an inflammatory infiltrate in the left paratonsillar region was determined, the tonsil was displaced medially and downward. The right half of the oropharynx is intact. Breathing is free. Laryngoscopy was not performed due to trismus of masticatory muscles.

 The skin of the neck surface and the scanning sensor were treated with petroleum jelly. The sensor of the apparatus for ultrasound diagnostics is installed in the submandibular region parallel to the body of the lower jaw on the corresponding side, and then it was moved along the lateral surface of the neck down and somewhat posteriorly. Another scanning plane is presented when the sensor is installed parallel to the lower jaw branch, somewhat posterior to it. The ultrasound source was moved up and down. Thus, scanning was performed in two mutually perpendicular planes: horizontal and sagittal.

 On the echogram in the horizontal plane of scanning, a roundish formation with clear contours and heterogeneous hypoechoic content with dimensions of 32.3 • 26.9 mm is defined. On the echogram in the sagittal plane, formation with the same clear boundaries and an inhomogeneous hypoechoic structure is determined. Its shape is elongated, ovoid, dimensions 49.2 • 30.0 mm. Thus, on the basis of clinical and ultrasound data, a paratonsillar abscess was diagnosed. The duration of the study was 10-12 minutes.

 A day later, the patient underwent an abscessesillectomy, during which an anterior-upper paratonsillar abscess was opened. Stand out about 7.0 ml of pus. The postoperative period was uneventful. On the 6th day, the patient was discharged for outpatient treatment.

 We give an extract from another medical history.

Patient K., 28 years old, was admitted to the ENT department of the Republican Oncological Dispensary, case history 365, with complaints of pain in the throat on the left, body temperature up to 38.0 ^o C. It is known from the anamnesis that he was ill for 5 days, took erythromycin tablets 1 at a time 0 g per day. The condition did not improve, the pain intensified. He was hospitalized with a diagnosis of "paratonsillar abscess" on the left. Suffers from chronic gastroduodenitis. At the time of admission to the hospital - remission.

 On examination: the patient's condition is satisfactory. There is a trismus of chewing muscles, submandibular lymph nodes are slightly enlarged and painful. During pharyngoscopy, the inflammatory infiltrate in the left paratonsillar region was determined, the mucous membrane of the pharynx is moderately hyperemic. The left tonsil is displaced inwards.

 Ultrasound imaging visualizes superficially located hypoechoic incomplete formations with a homogeneous structure (lymph nodes). In the paratonsillar region, a purulent focus was not detected. A preliminary diagnosis was made: "acute paratonsillitis" and on November 30, 1999, incision was performed to reduce tension in the tissues. With this manipulation, blood was released with a small amount of cloudy discharge in a volume of not more than 0.5 ml. The patient's condition improved, the temperature returned to normal on the 3rd day, trismus regressed. Antibacterial and anti-inflammatory therapy was carried out. Discharged for outpatient treatment on the 8th day.

 The proposed method was tested in the ENT department of ROD in 26 patients and showed positive results.

Compared with the prototype of the proposed method has the following advantages:
1. Defined clear diagnostic signs of the stages of paratonsillar abscess.

 2. There is the possibility of adequate treatment of paratonsillar abscess.

 Thus, the proposed method for the diagnosis of paratonsillar abscess will allow a timely set of therapeutic measures with patients.

Claims (1)

 A method for diagnosing a paratonsillar abscess by evaluating reflected ultrasound signals from tissues, characterized in that they perform ultrasound scanning of the surface of the cervical region in the longitudinal and transverse planes, determine the ultrasound symptom complex and in the presence of a rounded shape with a border in the form of a white-gray line, blurred outlines of formation and heterogeneities of the contents of the cavity diagnose a paratonsillar abscess.