Pott’s puffy tumor: A quiet enemy. Case series in Georgia-USA

Congress:

ECR 2020

Poster Number:

C-05118

Type:

Educational Exhibit

Keywords:

Performed at one institution, Not applicable, Inflammation, Infection, Abscess, Drainage, Biopsy, Abscess delineation, MR, CT, Head and neck, Emergency, Ear / Nose / Throat, Head and Neck

Authors:

A. M. Bonilla Ruiz¹, K. Sotomayor², F. Bustamante², C. Scelsi², G. Kramer², R. Figueroa², G. Palacios², S. Forseen², B. Gilbert²; ¹Lima, Li/PE, ²Augusta, GA/US

DOI:

10.26044/ecr2020/C-05118

DOI-Link:

https://dx.doi.org/10.26044/ecr2020/C-05118

Fig. 9: 1. POTTS PUFFY TUMOR" (EXCISION):Benign fibro-connective, adipose and scant...

Fig. 3: Axial CT soft tissue window shows left frontal sinus dehiscence with left...

Fig. 8: T1 + C shows intracranial and intraparequimal dissemination, with epidural...

Fig. 4: Sagittal T1+C shows left frontal sinus dehiscence with left anterior frontal...

Learning objectives

We aim toreview the main features of Pott's Puffy Tumor by CT and MRI. To use a case format approach to illustrate these features, in order that doctors in training may keep them in mind.

Background

Pott’s puffy tumor is an extremely rare complication of frontal sinusitis. It is characterized by a chronic frontal sinusitis with sinus wall osteomyelitis and with a subperiosteal abscess, more common encountered in the paediatric population. It isalso occasionallydescribed after head trauma. This entity is frequently missed due to its slow insidious onset and low grade lingering pressure headache masking the frontal sinus inflammatory process,with often delayed diagnosis. Presenting symptoms and signs can be non-specific, and by the time the diagnosis is suspected intracranial complications have...

Findings and procedure details

Allfour patients underwent maxilofacial CT and 3 Tesla MR imaging. We show two teenage patients, one adult man and one older adult woman. The firsttwo patients (12 and 13-years-old boys), were previously healthy. They present with orbital cellulitis, pansinusitis, and forehead swelling/tenderness for few days. In the first case (12-years-old boy), CT shows bony irregularity extending superiorly from the central aspect of the frontal sinus, connecting with focal area of bony erosion/destruction within the central aspect of the frontal bone just superior to the frontal...

Conclusion

Pott's puffy tumor is a low grade insidious complex frontal sinus infection that may present in advanced stages with intracranial disease extension. Contrast-enhanced CT is often the initial key for diagnosis, but MRI is the optimal imaging tool to evaluate magnitude of intracranial and skull base extension of the dissease. Early surgical treatment significantly contributes to favorable outcome and decreases the risk ofcentral nervous system complications.

Personal information and conflict of interest

A. M. Bonilla Ruiz; Lima, LI/PE - nothing to disclose K. Sotomayor; Augusta, GA/US - nothing to disclose R. Figueroa; Augusta, GA/US - nothing to disclose G. Kramer; Augusta, GA/US - nothing to disclose F. Bustamante; Augusta, GA/US - nothing to disclose S. Forseen; Augusta, GA/US - nothing to disclose B. Gilbert; Augusta, GA/US - nothing to disclose G. Palacios; Augusta, GA/US - nothing to disclose C. Scelsi; Augusta, GA/US - nothing to disclose

References

Acke F, Lemmerling M, Heylbroeck Ph, De Vos G and Verstraete K.POTT’S PUFFY TUMOR: CT AND MRI FINDINGS.JBR–BTR, 2011, 94: 343-345. Escudero R,PérezI. y Del Estad G. Tumor hinchado de Pott:una complicación olvidada de la sinusitis.Radiología. 2011;53(2):175-178. Rajwani K, Ketan D and Simione L.Forehead swelling and frontal headache:Pott’s puffy tumour.BMJ Case Rep 2014, bcr-202737.