Spontaneus tonsillar hemorrhage

Revista Brasileira de Otorrinolaringologia

Rocha, Savya Cybelle Milhomem¹  USP¹  Faculdade de Medicina de Marília¹  Dell’Aringa, Alfredo Rafael¹  Melo, Cinthia de¹  Kobari, Kazue¹  Nardi, José Carlos¹ 

关键词: peritonsillar abscesses;    von willebrandÂ’s disease;    spontaneous tonsillar hemorrhage;    infectious mononucleosis;    measles;   

DOI  :  10.1590/S0034-72992007000200025

学科分类：医学（综合）

来源: Associacao Brasileira de Otorrinolaringologia e Cirurgia Cervicofacial

【 摘 要 】

Spontaneous tonsillar hemorrhage is a rare event; most of these cases have been the result of infectious tonsillitis.1 There are reported cases of spontaneous tonsillar hemorrhage in medical literature associated with bacterial infection, measles virus infection, infectious mononucleosis, peritonsillar, parapharyngeal and retropharyngeal abscesses and, less frequently, vascular malformation, aneurisms or pseudoaneurisms of the carotid and superficial temporal arteries, von WillebrandÂ’s disease and local or regional cancer.1,2In a review of literature, Lourenço et al.1 found 21 cases of spontaneous tonsillar hemorrhage resulting from acute tonsillitis. Cases of spontaneous hemorrhage have been reported in peritonsillar abscesses, mostly when spontaneous drainage occurred during the pre-antibiotic era.1The prevalence of hemorrhage associated with infectious mononucleosis is 3 to 6.9%; of these, 2.2% presented oropharyngeal hemorrhage.1,2,3 Thrombocytopenia is associated with this condition, but hemorrhage may result only due to local inflammation, necrosis and erosion of superficial tonsillar blood vessels.1In measles, hemorrhagic complications are uncommon. However, there is a rare variant known as hemorrhagic measles that affects mostly immunocompromised patients.4Tonsillar hemorrhage is a rare finding in von WillebrandÂ’s disease. There are 2 cases reported in literature where tonsillar hemorrhage was the first manifestation of this disease.5An explanation of the pathophysiology of this type of hemorrhage is that acute inflammation results in increased blood flow to the tonsils, secondary edema, and vascular congestion; during the local inflammatory process, superficial dilated blood vessels undergo necrosis and bleed.1In the pre-antibiotic era these hemorrhages were fatal; they were commonly due to erosion of major vessels, secondary do deep abscesses. Currently, most tonsillar hemorrhages are mild and result from the bleeding of superficial peripheral blood vessels.1We report the following

【 授权许可】

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