Spontaneous tonsillar hemorrhage

Abstract

Spontaneous tonsillar hemorrhage (STH) of non-iatrogenic causes occurs most frequently from infection. Infection can lead to erosion into a major vessel, such as the carotid artery or a smaller peripheral tonsil vessel. Whereas fatal erosion into a major vessel from a deep neck abscess was relatively common in the past, it is rare since the advent of antibiotics. Spontaneous tonsillar hemorrhage, when it does occur, appears to occur most commonly in a peripheral tonsil vessel from bacterial tonsillitis. Medical records of 860 patients with conditions considered to be susceptible to STH were reviewed. Ten cases of STH were identified. All were from peripheral tonsil vessel hemorrhage; none was secondary to major vessel erosion. Bacterial tonsillitis was the most common cause of STH and occurred in 8 of 10 cases. This condition accounted for an incidence of STH in tonsillitis of 1.1%. A history of chronic tonsillitis appeared to predispose a patient to STH. Other causes of STH were infectious mononucleosis and neoplasm. Seven of the ten peripheral STHs presented with bleeding from an obvious venous source. The other three patients had significant hemorrhages which led to arteriography. Arteriograms are indicated in patients with clinical features suggesting possible major vessel erosion or in those patients where significant bleeding is not from an obvious peripheral source. A peripheral STH can be successfully managed with local intervention and tonsillectomy.

Indications for tonsillectomy stratified by the level of evidence

“…In cases of suspected malignoma, the indication is not under discussion and clear [547] (grade B), [548], [549] (grade C).…”

Tonsillitis and sudden childhood death

“…[4][5][6][7] Spontaneous hemorrhage is an unusual occurrence in children with acute tonsillitis, being documented in only 1.2% of cases in one series. 8 Although survival is possible with conservative management in cases of superficial hemorrhage, deeper infections that have involved major vessels may result in catastrophic bleeding with rapid demise, as in case 1 where there had been infiltration of the right internal carotid artery with pseudoaneurysm formation.…”

Amigdalitis hemorrágica: Presentación de un caso

“…La amigdalitis hemorrágica, desde el advenimiento de la era antibiótica, es una complicación atí-pica de cuadros faringoamigdalinos, presentándose mayormente asociada a abscesos periamigdalinos y amigdalitis aguda o crónica 3,4 . La amigdalitis hemorrágica se define como un sangrado amigdalino persistente por más de 1 hora o un sangrado mayor a 250 cc independiente del tiempo de sangrado 4 .…”

“…La amigdalitis hemorrágica se define como un sangrado amigdalino persistente por más de 1 hora o un sangrado mayor a 250 cc independiente del tiempo de sangrado 4 . Su tratamiento no está del todo definido debido a lo poco frecuente del cuadro y los escasos casos reportados en la literatura.…”

“…Las recomendaciones descritas en la literatura van desde un manejo mé-dico conservador hasta la amigdalectomía 5 . El sangrado estaría explicado por un aumento importante del flujo sanguíneo, dilatación de los vasos, edema, congestión vascular y necrosis superficial de las amígdalas en el contexto de la reacción inflamatoria que produce la infección 4,6 . La hemorragia es principalmente de origen venoso, con un sangrado difuso del parénquima o de focos aislados secundarios a úlceras 7 .…”