Neuroradiology Department, Hospital Dona Estefânia e Hospital São José, Centro Hospitalar Universitário de Lisboa Central – CHULC
- XV Congresso Nacional da SPNR, 28-29 Junho 2019, Coimbra
- Neuroradiology (2020) 62:109–127. https://doi.org/10.1007/s00234-019-02317-7
INTRODUCTION: Pott’s puffy tumor (PPT) is defined as a forehead subperiosteal abscess secondary to frontal osteomyelitis. It was first described by Sir Percivall Pott as a local subperiosteal abscess due to frontal bone suppuration resulting from trauma. Nowadays, given the widespread use of antibiotics, this is an extremely rare complication. Frontal sinusitis and trauma remain the most common causes.
MATERIAL AND METHODS: We report a case of a 16 year old boy with PPT caused by frontal sinusitis and trauma.
RESULTS: A 16 year old boy presented at the emergency department with swelling and redness on the left aspect of the forehead, accompanied by headache and fever. One week earlier he had suffered an accidental self-inflicted frontal head trauma with his cellphone while texting laying on his bed. Neurological examination was unremarkable. Head CT scan and brain MRI were performed revealing extensive sinusitis of the frontal sinus and left ethmoidal cells and maxillary sinus, along with bony erosion and a bony defect involving both the anterior and posterior left frontal sinus walls. Additionally, a large left epicranial abscess and left frontal epidural abscess were visible. Reactional thickening of the adjacent duramater was also present. The patient was started on antibiotics and underwent urgent epicranial abscess aspiration and endonasal sinus surgery. Follow-up imaging studies showed resolution of the epicranial and epidural abscesses as well as of the sinus infection.
CONCLUSIONS: Further complications in PPT include extradural or cerebral abscess, orbital cellulitis or abscess, cavernous sinus or cortical vein thrombosis, meningitis and chronic osteomyelitis of the frontal bone. These complications have been observed in 60% of patients and result from the direct extension of the infection or more commonly from secondary septic thrombophlebitis. Surgical intervention is the treatment of choice along with prolonged antibiotic therapy.
Palavras Chave: Pott´s puffy tumor; sinus; abscess; head trauma; imaging