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CT Neck Tonsillitis

TECHNIQUE: Axial images from the skullbase through the thoracic inlet after the administration of IV contrast were obtained. Coronal and sagittal reformations were provided.

There is bilateral palatine and the lingular tonsillar enlargement.
There is no ring enhancing collection or definite drainable fluid collection.
There is enlargement of multiple level 2 lymph nodes. The largest is in the right measuring 1.6 x 1.5 x 3.5 cm.
Multiple additional smaller lymph nodes are noted throughout the bilateral anterior and posterior cervical chain, likely reactive as well.
The visualized portions of the brain and the posterior fossa are normal.
The paranasal sinuses and orbits are normal.
The salivary glands, including the parotid glands and submandibular glands, are normal.
The larynx, hypopharynx, and thyroid gland are normal.
There is some debris seen anterior to the epiglottis.
No bone abnormalities are demonstrated.
The visualized portions of the lung apices are normal.
Normal vascular enhancement is seen.

IMPRESSION: Findings are consistent with tonsillitis with likely reactive mandibular lymphadenopathy. There is no definitive drainable fluid collection at this time.
There is enlargement of the bilateral pharyngeal tonsils which make contact at the midline.
There is soft tissue attenuation which blur the surrounding fat planes with no focal fluid collections identified to suggest peritonsillar abscess.
The adenoids are prominent.
There is apparent bilateral pockets of gas within the adenoid tonsils as well as areas of low attenuation.
There is moderate diffuse cervical lymphadenopathy.
The demonstrated airway is patent, without abnormal narrowing or filling defects.
The demonstrated blood vessels and bones are normal.
Minimal mucosal thickening is noted in the right maxillary sinus.

Conclusion: Very prominent adenoid and pharyngeal tonsils with lymphadenopathy is compatible with infectious process. No focal fluid collections identified to suggest peritonsillar abscess. Pockets of gas and low attenuation within the adenoids is concerning for suppurative infection with early abscess a possibility. Recommend close clinical follow-up to ensure resolution of adenopathy and enlarged tonsils.