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  • • Sudden onset

    • Often follows an upper respiratory tract infection

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Epidemiology

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  • • Rare condition

    • 50% of patients have preexisting thyroid disease

    • Peak incidence in childhood or young and middle-age adults

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Symptoms and Signs

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  • • Acute neck pain, exacerbated by neck extension

    • Dysphagia

    • Fever, chills

    • Neck enlargement

    • Warmth and erythema

    • Hemoptysis

    • Cervical lymphadenopathy

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Laboratory Findings

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  • • Leukocytosis

    • Normal thyroid function

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Imaging Findings

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  • • Barium swallow (if suspect piriform sinus) demonstrates fistulous tract

    • Areas of decreased uptake on thyroid scan (if associated abscess)

    • Partially cystic mass seen on thyroid US

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  • • Percutaneous aspiration, with Gram stain and culture often yields diagnosis

    • Most common organisms are:

    • -Streptococci

      -Staphylococci

      -Pneumococci

      -Coliforms

    • May be associated with a piriform sinus fistula

    • Extremely rare causes include:

    • -TB

      -Actinomycoses

      -Echinococcosis

      -Aspergillosis

      -Syphilis

    • Infection usually arises from drainage from local structures but can also be hematogenously spread or after direct trauma

    • Blood-tinged sputum suggest tracheal involvement

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Rule Out

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  • • Chronic suppurative thyroiditis

    • De Quervain thyroiditis

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  • • History and physical exam

    • Needle aspiration, with Gram stain and culture of aspirate

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  • • Primary treatment is antibiotics

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Surgery

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  • • Thyroid abscess drained operatively

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Indications

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  • • Thyroid abscess

    • Cysts communicating with the piriform sinus or trachea (surgery to excise this fistula should be done after the infection has been completely eradicated)

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Medications

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  • • Antibiotics are indicated in all cases

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Treatment Monitoring

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  • • Improvement should occur within 48-72 hours of starting antibiotics, with complete resolution after 2-4 weeks

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References

Brook I: Microbiology and management of peritonsillar, retropharyngeal, and parapharyngeal abscesses. J Oral Maxillofac Surg 2004;62:1545.  [PubMed: 15573356]

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