BACKGROUND Tonsillitis, with associated tonsillar hypertrophy, is a common disease of childhood, yet it is rarely associated with sudden death due to airway obstruction. Lethal complications involving the inflamed tonsils include haemorrhage, retropharyngeal abscess and disseminated sepsis. CASE PRESENTATION We report on a case of sudden and unexpected death in an 8-year-old female who was diagnosed with and treated for tonsillitis. The child was diagnosed with acute tonsillitis 2 days prior to her collapse and was placed on a course of oral antibiotics. There were no signs of upper or lower airway obstruction. She was found to be unresponsive by her caregiver and gasping for air in her bed in the early hours of the second morning after the start of treatment. Autopsy showed massive and symmetrically enlarged palatine tonsils. The tonsils filled the pharynx almost completely. The epiglottis and laryngeal mucosa at the base of the epiglottis in the vicinity of the aryepiglottic membrane and the superior aspect of the larynx displayed red-purple discoloration, with mucosal swelling and edema. Histological examination of the palatine tonsils revealed prominent lymphoid hyperplasia, but no evidence of acute inflammation. CONCLUSION Palatine tonsillar hypertrophy in infants is a common feature of both viral and bacterial tonsillitis and has been postulated as a possible risk factor for Sudden and Unexplained Death in Infancy (SUDI), based on the theory of mechanical impediment of breathing by narrowing of the upper airway. The rounded shape of the tonsils may facilitate some airflow past the enlarged structures and hence protect against asphyxial death when the enlarged tonsils fill the laryngo-pharynx. Epiglottal and proximal laryngeal edema may play a more significant role in asphyxial unexpected deaths in cases of tonsillitis with tonsillar hypertrophy than previously suspected. This focusses the importance of careful examination of the epiglottis and proximal laryngeal mucosa, as part of a thorough examination of the laryngo-pharynx in cases of sudden death associated with tonsillar hypertrophy.

中文翻译：

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小儿扁桃体肥大和脱垂-会厌炎是否是突然意外死亡的诱因？

背景技术扁桃体炎及其相关的扁桃体肥大是儿童时期的常见疾病，但很少与因气道阻塞而导致的猝死有关。涉及扁桃体发炎的致命并发症包括出血，咽后脓肿和脓毒症。病例介绍我们报告了一例8岁女性的突然和意外死亡的案例，该女性被诊断为扁桃体炎并接受了治疗。患儿崩溃前2天被诊断出患有急性扁桃体炎，并接受了口服抗生素疗程。没有上呼吸道或下呼吸道阻塞的迹象。治疗开始后第二天清晨，她的照顾者发现她反应迟钝，并在床上喘气。尸检显示肿块且对称增大的ala扁桃体。扁桃体几乎完全充满了咽部。在会厌膜附近和会厌上界的会厌基部的会厌和喉粘膜表现出红紫色变色，并伴有粘膜肿胀和水肿。p扁桃体的组织学检查显示明显的淋巴样增生，但没有急性炎症的迹象。结论婴儿扁桃体扁桃体肥大是病毒性扁桃体炎和细菌性扁桃体炎的共同特征，根据上肢收窄的机械性呼吸障碍理论，据推测是婴儿期突然和不明原因死亡的可能危险因素（SUDI）呼吸道。扁桃体的圆形形状可以促进一些气流通过增大的结构，因此当增大的扁桃体充满喉咽时可以防止窒息死亡。与扁桃体肥大相比，扁桃体炎患者在窒息性窒息性意外死亡中，会厌和喉头近端水肿的作用可能比以前预期的要重要。这集中了对会厌和咽喉近端粘膜进行仔细检查的重要性，这是对因扁桃体肥大而猝死的喉咽进行彻底检查的一部分。