The case: A 3 year old with neck swelling and concern for neck infection who will not tolerate a CT scan.

Here’s how you answered the questions:

Discussion and Denouement: This patient represents an unusual presentation for peritonsillar abscess in both his young age and his primary complaint being external neck swelling.  Although not all PTAs require CT imaging prior to drainage, ENT here agreed with radiology in the need for a contrast CT.  The disucssion largely focused on sedation choices for this patient. Most felt that sedation was within our PEM purview, and the choice of agent varied, with most advocating for pentobarbital or ket We were lucky in this particular case that a quiet day in radiology allowed for multiple attempts at imaging without sedation, and we ultimately obtained useful images.  The patient was admitted overnight and proceeded to the operating room for an uncomplicated I&D the following day.  His abscess cultures grew Strep pyogenes and he was discharged home to complete 10 days Augmentin.  At his 1-month follow-up visit, he was well without any residual problems.

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