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Updated 08 June 2015

Answer: What's your diagnosis? – Case 13

In our latest case, Ms X presented to her GP with a s very painful throat. The most likely diagnosis, based on her history, is a peritonsillar abscess, also known as quinsy.

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In our latest case, we met Ms X who went to her GP complaining about an excruciatingly painful throat. You can read the full case study here.

The most likely diagnosis is a peritonsillar abscess (PTA), otherwise known as quinsy.  This very painful condition is usually a complication of tonsillitis and occurs when pus forms between the tonsils and the surrounding soft tissue.

Patients suffering from a peritonsillar abscess usually complain of severe pain on the one side of the throat. They report difficulty swallowing, and in severe cases can even struggle to breathe. This condition usually requires immediate attention, and the doctor will make sure that the airway does not become obstructed due to severe swelling.

Why this diagnosis?

Looking at her symptoms, Ms X said she had severe pain on the right side of her throat that went along with difficulty swallowing, but luckily she had no problems breathing. She also had fever and pain in her right ear, which could have been caused by referred pain (pain that is felt elsewhere in the body and not at the source of the pain).

While examining her, the doctor noted that Ms X spoke softly and that saliva gathered at the corners of her mouth – further suggesting that she has difficulty swallowing because of pain.

On taking a closer look at her throat, the very red, swollen mass on the right side of her throat in the area of the tonsillar bed was typical of a peritonsillar abscess.  The fact that the uvula appeared to be pushed to the left side of throat also suggests abscess formation.

How is a peritonsillar abscess treated?

The most important aspect of managing a peritonsillar abscess is to make sure the airway is not endangered. If so, the doctor will place a needle in the abscess and try to drain it. If the airway is still open, the doctor will refer the patient for possible incision and drainage of the abscess.  In cases where incision is needed, the doctor will admit the patient to the hospital. The doctor will also prescribe antibiotics and pain relief medication. 

NOTE: Health24's on-site GP Dr Owen Wiese reveals new cases on Thursdays. The answer is posted with the story on Mondays, or you can get it in our Daily Tip – sign up here.

Previously on What's Your Diagnosis?

What's your diagnosis? – Case 1: vomiting and weight loss

What's your diagnosis? – Case 2: eye pain

What's your diagnosis -  Case 3: strange behaviour and a bullet in the back

What's your diagnosis - Case 4: seeing odd things

What's your diagnosis - Case 5: mysterious lungs

What's your diagnosis - Case 6: runner with seizures

What's your diagnosis - Case 7: swollen knee

What's your diagnosis - Case 8: bloody semen

What's your diagnosis - Case 9: confusing neurological signs

What's your diagnosis - Case 10:diabetic teenager with unusual signs and symptoms

What's your diagnosis - Case 11:bruising with no apparent cause

What's your diagnosis - Case 12: severe tummy pain

Image: James Heilman, MD (Own work) [CC BY-SA 3.0], via Wikimedia Commons

Dr. Owen J. Wiese is Health24's resident doctor. After graduating from Stellenbosch University with additional qualifications in biochemistry and physiology he developed a keen interest in providing medical information through the media.

 
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