A Case of a Large Peritonsillar Abscess

TL;DR

A patient with a peritonsillar abscess and diabetes suddenly deteriorated, highlighting the need for early airway management in high-risk cases.

Contribution

This case highlights the sudden deterioration risk in PTA patients with comorbidities and emphasizes the importance of early airway intervention.

Findings

An obese diabetic male with PTA experienced sudden cardiac arrest during a positional change.

CT imaging revealed a large abscess compressing the airway despite initial stable oxygenation.

Percutaneous tracheostomy during chest compressions restored circulation without neurological deficits.

Abstract

A patient with a peritonsillar abscess (PTA) may initially appear clinically stable, but certain risk factors can predispose to a sudden airway obstruction. Those risk factors include being a young-to-middle-aged male, obesity (defined as a BMI ≥30.0 kg/m²), or diabetes. An obese 52-year-old diabetic male presented to the emergency department with throat pain, trismus, and a muffled voice. CT imaging of the neck without contrast showed a large abscess extending into the parapharyngeal space and compressing the airway anteriorly. Although he initially had normal oxygenation, he suddenly lost consciousness and experienced cardiac arrest during a positional change during the gurney-to-bed transfer. Intubation was not possible due to mechanical obstruction, and a percutaneous tracheostomy was performed during chest compressions. Return of spontaneous circulation was achieved, and the patient recovered without neurological deficits. This case demonstrates that patients with PTA and certain comorbidities may suddenly deteriorate, even when they initially appear clinically stable. Early airway management is essential when the risk factors are present.

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