Spontaneous Tonsillar Hemorrhage: Advances in Acute Management, Diagnostic strategies and Long-Term Care – Insights from Recent Case Studies and a Comprehensive Literature Review
نویسندگان
1 Department of Radiology, Head and Neck Surgery, University of Szeged, Hungary.
2 Department of Radiology, Head and Neck Surgery, University of Szeged, Hungary.
3 Department of Otorhinolaryngology, Head and Neck Surgery, University of Szeged, Hungary.
4 Department of Radiology, Head and Neck Surgery, University of Szeged, Hungary.
5 Department of Otorhinolaryngology, Head and Neck Surgery, University of Szeged, Hungary.
6 1. Department of Otorhinolaryngology, Head and Neck Surgery, University of Szeged, Hungary. 2. Department of Radiology, Head and Neck Surgery, University of Szeged, Hungary
doi
10.22037/orlfps.v10i1.47678چکیده
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.
