Head & neck imagingCase Type
Anatomy and Functional ImagingAuthors
Paula Concejo Iglesias, Jimena Cubero Carralero, Wilmar Antonio Ocampo Toro, María Pilar Núñez Valentín, María Azahara Hoyas García, Carlos Bartels Urvina, Cristian Rodríguez Robles, Concepción Ferreiro ArgüellesPatient
23 years, female
A 23-year-old female without relevant medical history. A cervical ultrasound was performed to rule out goiter.
A hypoechogenic well defined structure with striated appearance was demonstrated on grey-scale ultrasound with small air foci inside the lesion. The submandibular gland and mylohyoid muscle are unremarkable.
The palatine tonsils are part of the Waldeyer´s ring, lymphoid tissue located in the nasopharynx and oropharynx [1, 2, 3]. The Waldeyer´s ring is especially important in the pediatric population since they have more tendency to suffer from infectious or inflammatory processes . When bigger than normal, they may be a cause of sleep apnea .
Ultrasound is an excellent imaging technique in the neck exploration of pediatric and young population because of its availability, the fact that it is a noninvasive technique and the lack of ionizing radiation, ionidated intravenous contrast or sedation necessity [1, 2, 3, 4].
On ultrasound a palatine tonsil is seen as a hypoechogenic well-circumscribed lesion [1,3-5] with a typical internal striated appearance. It is in the pharyngeal mucosal space, deep to the submandibular gland and the mylohyoid muscle [2, 3]. The characteristic internal striated appearance with alternating hypo- and hyperechogenic linear bands is due to the presence of tonsillar crypts [1 - 4]. Inside the crypts, small air foci can be also seen [2, 3].
When an inflammatory process is developing, such as tonsillar cellulitis or abscess, the striated appearance disappears . In tonsillar cellulitis an enlarged tonsil with obscured borders may be visualized, while abscess is defined by an anechogenic cystic lesion inside the tonsil or in the paratonsillar tissue [2, 3, 5].
There are no differences in size between males and females  and there are also no commonly accepted normal values for the dimension of the palatine tonsils. Maximum size is usually during puberty [1- 4], up to 2 cm in longitudinal dimension [2, 3, 5].
Knowledge of the normal ultrasound characteristics and features of the palatine tonsil is mandatory for radiologists in order to avoid misdiagnosis [2, 3].
 Hosokawa, T., Yamada, Y., Tanami, Y., Hattori, S., Sato, Y., Hosokawa, M., & Oguma, E. (2017). Evaluation of the normal tonsils in pediatric patients with ultrasonography. Journal of Ultrasound in Medicine, 36(5), 1029-1036. doi: 10.7863/ultra.16.05083. PMID: 28093800
 Bandarkar, A. N., Adeyiga, A. O., Fordham, M. T., Preciado, D., & Reilly, B. K. (2016). Tonsil ultrasound: technical approach and spectrum of pediatric peritonsillar infections. Pediatric radiology, 46(7), 1059-1067. PMID: 26637999
 Candela, V. P. (2019). Estudio ecográfico de las amígdalas palatinas por la vía transcutánea en pediatría. Canarias Pediátrica, 43(3), 212-218.
 Hong, H. S., Lee, J. Y., & Jeong, S. H. (2018). Normative values for tonsils in pediatric populations based on ultrasonography. Journal of Ultrasound in Medicine, 37(7), 1657-1663. PMID: 29274081, DOI: 10.1002/jum.14513
 Secko, M., & Sivitz, A. (2015). Think ultrasound first for peritonsillar swelling. The American journal of emergency medicine, 33(4), 569-572. PMID: 25737413, DOI:10.1016/j.ajem.2015.01.031
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