Pediatric tonsillar pathology: a comprehensive ultrasonographic approach

Palatine tonsils are part of the Waldeyer's ring and consist of lymphoid tissue. As a first-line immune system mechanism, they act against entering pathogens. They recognize and initiate an immune response to exogenous antigens. Tonsillar disease in children, particularly inflammatory conditions, is well known in the medical community. Inflammatory diseases include conditions such as tonsillitis and peritonsillar cellulitis and other more complicated diseases such as intratonsillar abscess, peritonsillar abscess, and parapharyngeal abscess. Their treatment varies, with more severe cases often requiring intervention when antibiotic therapy is insufficient. Prompt differential diagnosis should be performed to prevent the misdiagnosis of life-threatening conditions, including neoplastic disease, which may present with clinical and imaging findings mimicking an inflammatory process. An intraoral or transcutaneous ultrasonographic approach in such patients can help differentiate cases that eventually require intervention, without the risk of ionizing radiation. This article aims to analyze the ultrasound findings of normal tonsillar tissue and to categorize abnormal findings indicative of tonsillar disease.