Spontaneous Tonsillar Hemorrhage: Advances in Acute Management, Diagnostic strategies and Long-Term Care – Insights from Recent Case Studies and a Comprehensive Literature Review
Journal of Otorhinolaryngology and Facial Plastic Surgery,
Vol. 10 No. 1 (2024),
13 March 2024
,
Page 1-9
https://doi.org/10.22037/orlfps.v10i1.47678
Abstract
Background: Spontaneous tonsillar hemorrhage (STH) is a rare complication of acute or chronic tonsillitis, with 63 cases reported in the literature. Despite these, no consensus exists on therapeutic pathways for STH.
Case presentation: Case 1: A 26-year-old presented with hemoptysis and a 2x3mm coagulum on the right tonsil. After admission and administration of dicynone, a significant bleed of 350ml occurred. Bleeding was controlled under general anesthesia using bipolar diathermy. CT angiography and MRI revealed a blood-filled cavity caused by erosion of the descending palatine artery. Digital subtraction angiography (DSA) confirmed this and was followed by super-selective embolization.
Case 2: A 46-year-old presented with hemoptysis and a 5x5mm coagulum on the right tonsil. The bleed was managed with bipolar diathermy. CT angiography showed a right tonsillar abscess without arterial malformations. Case 1 represents the first reported use of DSA and embolization to manage STH caused by an aberrant artery.
Conclusion: These cases and a literature review informed a diagnostic and therapeutic protocol for STH. Vascular malformations must be excluded before emergency tonsillectomy, with DSA playing a key role in identifying and managing arterial involvement.
- Spontaneous Tonsillar Hemorrhage; Tonsillectomy; Digital subtraction angiography; Endovascular intervention.
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