Case of the Week
Section Editors: Matylda Machnowska1 and Anvita Pauranik2
1University of Toronto, Toronto, Ontario, Canada
2BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
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April 16, 2015
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.
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