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So this was the patient that presented

0:02

with left-sided throat pain and had a

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fever and had difficulty swallowing.

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And what we see here on this contrast-enhanced CT

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scan is diffuse inflammation and thickening involving

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the left tonsil and the parapharyngeal space.

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So this is an example of phlegmon

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as opposed to an abscess.

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So let's draw a line down the middle

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and compare one side to the other side.

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On the uninvolved side, we can see—

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it's the medial pterygoid muscle, and we can see

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the normal fat involving the parapharyngeal

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space, and we can see the right tonsil.

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On the patient's left-hand side,

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we see diffuse thickening involving the tonsil.

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We see diffuse edema involving the parapharyngeal space,

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and we do see some areas

0:45

of low attenuation involving the tonsil.

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But realize that these are not well-defined fluid

0:52

collections that we would think is an abscess.

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Rather, this is phlegmon and diffuse inflammation

0:58

involving the tonsil and the peritonsillar region,

1:01

extending laterally into the parapharyngeal space.

1:04

More inferiorly,

1:05

we can see that this diffuse—

1:07

inflammation and edema and phlegmonous tissue

1:11

extend into the lower pole tonsil.

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And this is the epiglottis.

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We can see that the epiglottis is thickened,

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and in fact, when we look at the sagittal

1:18

image at the bottom right, we can also

1:20

see there's thickening of the epiglottis.

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So the inferior extent of this phlegmonic

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extends inferiorly into the glossotonsillar

1:28

sulcus, involves the epiglottis, and there's a piece of

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tissue that runs from the epiglottis to the pharynx.

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That's called the pharyngoepiglottic fold.

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So that's our inferior extent.

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The superior extent of this phlegmon

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extends above the level of the soft

1:42

palate and into the nasopharynx.

1:45

So the normal anatomy of the nasopharynx is—here’s our fossa of Rosenmüller.

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This is the torus tubarius, and this

1:51

is the opening of the eustachian tube.

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Notice all of this surface anatomy is effaced,

1:56

and this is because of all of this

1:58

deep phlegmon extending into the nasopharynx.

2:02

And then when we look at the sagittal

2:03

images here, we can see the diffuse

2:06

thickening here involving the soft palate.

2:09

So this is an example of a severe case of phlegmon

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involving the tonsil and peritonsillar region,

2:15

extends inferiorly into the lower pole of the tonsil,

2:19

and the pharyngoepiglottic fold, and superiorly—

2:22

it extends into the nasopharynx

2:24

with involvement of the soft palate.