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Enlarged Palatine Tonsils
A. Carlson Merrow, Jr., MD, FAAP; Lane F. Donnelly, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Clinical Issues

        TERMINOLOGY

        • Definitions

          • Palatine tonsils: Paired, discrete, round to ovoid masses of lymphoid tissue on either side of oropharynx
          • Enlargement may be chronic & idiopathic or acute/subacute (as from infection or neoplasm)
          • Chronic enlargement may lead to obstructive sleep apnea (OSA)

        IMAGING

        • General Features

          • Radiographic Findings

            • CT Findings

              • Ultrasonographic Findings

                • MR Findings

                  • Imaging Recommendations

                    DIFFERENTIAL DIAGNOSIS

                      PATHOLOGY

                      • Staging, Grading, & Classification

                        CLINICAL ISSUES

                        • Presentation

                          • Treatment

                            Selected References

                            1. Bandarkar AN et al: Tonsil ultrasound: technical approach and spectrum of pediatric peritonsillar infections. Pediatr Radiol. ePub, 2015
                            2. GuimarĂ£es AC et al: Clinical manifestations in children with tonsillar lymphoma: A systematic review. Crit Rev Oncol Hematol. 90(2):146-51, 2014
                            3. Donnelly LF: Magnetic resonance sleep studies in the evaluation of children with obstructive sleep apnea. Semin Ultrasound CT MR. 31(2):107-15, 2010
                            4. Ng SK et al: Reproducibility of clinical grading of tonsillar size. Arch Otolaryngol Head Neck Surg. 136(2):159-62, 2010
                            5. Bixler EO et al: Sleep disordered breathing in children in a general population sample: prevalence and risk factors. Sleep. 32(6):731-6, 2009
                            6. Fricke BL et al: Comparison of lingual tonsil size as depicted on MR imaging between children with obstructive sleep apnea despite previous tonsillectomy and adenoidectomy and normal controls. Pediatr Radiol. 36(6):518-23, 2006
                            7. Donnelly LF: Obstructive sleep apnea in pediatric patients: evaluation with cine MR sleep studies. Radiology. 236(3):768-78, 2005
                            8. Donnelly LF et al: Causes of persistent obstructive sleep apnea despite previous tonsillectomy and adenoidectomy in children with down syndrome as depicted on static and dynamic cine MRI. AJR Am J Roentgenol. 183(1):175-81, 2004
                            9. Donnelly LF et al: Upper airway motion depicted at cine MR imaging performed during sleep: comparison between young Patients with and those without obstructive sleep apnea. Radiology. 227(1):239-45, 2003
                            10. Donnelly LF et al: Correlation on cine MR imaging of size of adenoid and palatine tonsils with degree of upper airway motion in asymptomatic sedated children. AJR Am J Roentgenol. 179(2):503-8, 2002
                            11. Donnelly LF et al: Defining normal upper airway motion in asymptomatic children during sleep by means of cine MR techniques. Radiology. 223(1):176-80, 2002
                            Related Anatomy
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                            Related Differential Diagnoses
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                            References
                            Tables

                            Tables

                            KEY FACTS

                            • Terminology

                              • Imaging

                                • Clinical Issues

                                  TERMINOLOGY

                                  • Definitions

                                    • Palatine tonsils: Paired, discrete, round to ovoid masses of lymphoid tissue on either side of oropharynx
                                    • Enlargement may be chronic & idiopathic or acute/subacute (as from infection or neoplasm)
                                    • Chronic enlargement may lead to obstructive sleep apnea (OSA)

                                  IMAGING

                                  • General Features

                                    • Radiographic Findings

                                      • CT Findings

                                        • Ultrasonographic Findings

                                          • MR Findings

                                            • Imaging Recommendations

                                              DIFFERENTIAL DIAGNOSIS

                                                PATHOLOGY

                                                • Staging, Grading, & Classification

                                                  CLINICAL ISSUES

                                                  • Presentation

                                                    • Treatment

                                                      Selected References

                                                      1. Bandarkar AN et al: Tonsil ultrasound: technical approach and spectrum of pediatric peritonsillar infections. Pediatr Radiol. ePub, 2015
                                                      2. GuimarĂ£es AC et al: Clinical manifestations in children with tonsillar lymphoma: A systematic review. Crit Rev Oncol Hematol. 90(2):146-51, 2014
                                                      3. Donnelly LF: Magnetic resonance sleep studies in the evaluation of children with obstructive sleep apnea. Semin Ultrasound CT MR. 31(2):107-15, 2010
                                                      4. Ng SK et al: Reproducibility of clinical grading of tonsillar size. Arch Otolaryngol Head Neck Surg. 136(2):159-62, 2010
                                                      5. Bixler EO et al: Sleep disordered breathing in children in a general population sample: prevalence and risk factors. Sleep. 32(6):731-6, 2009
                                                      6. Fricke BL et al: Comparison of lingual tonsil size as depicted on MR imaging between children with obstructive sleep apnea despite previous tonsillectomy and adenoidectomy and normal controls. Pediatr Radiol. 36(6):518-23, 2006
                                                      7. Donnelly LF: Obstructive sleep apnea in pediatric patients: evaluation with cine MR sleep studies. Radiology. 236(3):768-78, 2005
                                                      8. Donnelly LF et al: Causes of persistent obstructive sleep apnea despite previous tonsillectomy and adenoidectomy in children with down syndrome as depicted on static and dynamic cine MRI. AJR Am J Roentgenol. 183(1):175-81, 2004
                                                      9. Donnelly LF et al: Upper airway motion depicted at cine MR imaging performed during sleep: comparison between young Patients with and those without obstructive sleep apnea. Radiology. 227(1):239-45, 2003
                                                      10. Donnelly LF et al: Correlation on cine MR imaging of size of adenoid and palatine tonsils with degree of upper airway motion in asymptomatic sedated children. AJR Am J Roentgenol. 179(2):503-8, 2002
                                                      11. Donnelly LF et al: Defining normal upper airway motion in asymptomatic children during sleep by means of cine MR techniques. Radiology. 223(1):176-80, 2002