Computerized tomography of acute, tender peritonsillar swellings

A randomized trial involving 40 consecutive patients with an acute painful peritonsillar swelling was set up to determine if an enhanced computerized neck tomogram was cost-effective or improved patient management. Each patient was placed into one of two groups. The first group had enhanced computerized tomography (CT) which allowed precise identification of a quinsy and this was aspirated with an 18G needle aspiration at the site directed by the scan. The second group of patients had 3-point permucosal 18G needle aspirations. A proportion of patients from each group, but primarily from the second, required immediate or delayed admission to hospital after aspiration, for persistent or recurrent symptoms. Costing each groups treatment, including the scan and hospitalization on intravenous antibiotics, we conclude that CT scanning prevents the morbidity associated with unsuccessful attempts at drainage in the patient with cellulitis and ensures complete drainage of pus, thereby optimizing patient treatment and it is cost-effective.