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Giant Tonsillolith Migration, Secondary Perforation, and an Associated Mediastinitis

  • Palatine tonsillolithiasis is a benign condition characterized by calcific foci in the tonsils that result from chronic bacterial infection in the tonsillar crypts.
  • In a recent study, the prevalence of asymptomatic tonsilloliths in 150 consecutive CT scans requested for reasons other than tonsillolithiasis was 24.6%, with no lesions exceeding 7 mm. Diagnosis of giant tonsilloliths has been reported in sporadic case presentations.
  • Tonsillolithiasis is asymptomatic. However, in cases of giant tonsilloliths, patients may complain of foreign body sensation, odynophagia or earache.
  • We are not aware of previous reports describing a tonsillolithiasis related life-threatening complication similar to the current case.
  • Descending cervical mediastinitis (DCM) is a rare but extremely severe disease caused by dissemination of a cervicofacial infection to the mediastinum along the fascial layers (retropharyngeal and danger spaces).
  • Rx: Surgical removal. Therapy of DCM is based on surgical drainage and debridement combined with intravenous broad-spectrum antibiotics and supportive care.
April 16, 2015
A 41-year-old HIV-positive man with good immunovirologic status presented with progressive odynophagia and foreign body sensation. He underwent a neck CT scan. One week later, the patient developed fever, dyspnea, and respiratory stridor. Follow-up CT scan is shown.
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