Spontaneous intratonsillar haemorrhage with acute dysphagia

In this brief study, we describe a rare tumorlike malformation of both tonsils, that we have named tonsilla partim pendulans. It seems to favour intratonsillar bleeding, resulting in enlargement and obstruction of the oropharynx. The presented case is a 34-year-old healthy woman without history of acute or chronic tonsillitis who complained of an oropharyngeal foreign body sensation since 1 day. Examination revealed a dark red and mobile tumor of 2 cm diameter attached to the lower part of the right tonsil. Furthermore, both tonsils showed a division into two hypertrophic parts. The stem of the tumor was coagulated and the tumor resected under local anaesthesia. Histology showed regular lymphoepithelial tissue with acute haemorrhage and an intact capsule. Actinomyces were found in the tonsillar crypts. Further physical and laboratory findings were unsuspicious. We conclude that patients with this newly described malformation of the tonsils can subsequently develop dysphagia, e.g. in combination with inflammation and mechanical stress. However, tonsillectomy seems not to be mandatory, though in more suspicious cases, histological investigation should exclude rare malignant tumors. Intratonsillar bleeding may cause oropharyngeal obstruction or even ongoing bleeding with relevant blood loss, which should be treated immediately.