Artikel
A pulsating tonsil
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Veröffentlicht: | 30. Juli 2013 |
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Gliederung
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We report the case of a 79 year-old woman, who presented in our department with an asymmetry of the palatine tonsils. The patient reported, that the asymmetry was first noted during an episode of angina she had three months ago and persisted ever since. Weight loss, fever or night sweats were not reported.
In order to get histological confirmation a tonsillectomy was planned. Clinically the tonsils were scarred without ulcerations or any signs of a carcinoma. Notable was a slight pulsation of the right tonsil. Based on this finding the patient underwent preoperatively a CT scan of the neck, which showed that the enlargement and subsequently the pulsation of the right tonsil was due to an aberrant internal carotid artery, without any contrast enhancement in the tonsillar tissues. The operation was thus cancelled in favour of regular controls.
Common causes of tonsillar asymmetry are infections or abscesses, while less common causes include the Angina plaut-vincenti, TBC and Lues. Furthermore carcinomas or lymphomas should be included in the differential diagnosis. Pulsations are due to an anomalous course of near-by blood vessels, something that should be excluded by appropriate imaging before performing a tonsillectomy in such patients.