03/04/2025
Pott's Puffy Tumour:
◾Pott’s Puffy Tumor is one of the most dangerous complications of frontal sinusitis, and is characterised by osteomyelitis of the frontal bone with an associated subperiosteal abscess.
◾It can occur in all ages but shows predilection for adolescents due to increased vascularization in diploic circulation of the frontal sinus in this age, which allows a faster spread of infection.
◾Pott’s Puffy Tumor is known to be secondary to untreated or partially treated sinusitis and in extremely rare cases due to mastoid surgery, dental infections, wrestling injuries, and insect bites.
◾The etiological agents most frequently are Streptococcus, Staphylococcus, Enterococcus, Bacteroides sp and anaerobic bacteria.
◾Clinical Evaluation:
➖Symptoms include frontal scalp and periorbital swelling, fever, purulent rhinorrhoea, photophobia, frontal sinus tenderness, vomiting, and signs of meningitis or encephalitis.
➖Pott’s Puffy Tumor is a predictor of intracranial complications such as meningitis, cavernous sinus and dural venous sinus thrombosis, orbital cellulitis with or without intraorbital abscess (if the inferior wall of the frontal sinus is involved) and epidural, subdural or intraparenchymal abscesses.
➖The spread of the infection can occur either due to direct extension by erosion of frontal sinus walls or by migration of septic thrombi through the diploic veins.
◾The imaging modality of choice to confirm the diagnosis is a CT scan that can evidence frontal sinusitis, bone erosion, subperiosteal collection, and extradural abscess.
◾MRI is the gold standard to detect the presence of intracranial complications as intracranial abscesses and dural sinus thrombosis.
◾Treatment:
➖The standard of care is intravenous broad-spectrum antibiotics with good pe*******on in CNS and anaerobic coverture for 4 to 6 weeks (clindamycin, ceftriaxone, metronidazole, vancomycin), along with surgical treatment as drainage of subperiosteal abscess, eradication of potential infection in sinuses, and treatment of possible intracranial complications.
➖Imaging follow-up should be performed with MRI.
◾Photo:
(A) Axial CT imaging of the orbits showing preseptal inflammation and swelling over the right brow (green arrow).
(B) External photograph showing right periorbital erythema and edema.
(C) Coronal MRI showing multiple abscess formation over the right frontal bone (red arrow) and in the epidural space (green arrows).
(D) Coronal MRI showing right sided subperiosteal abscess formation (red arrowhead).
Credit: www.eyewiki.org
Photo Credit: www.academic.oup.com
