Pott's Puffy Tumor

Archie R McGowan, MD
Carlo Buonomo, MD

September 3, 1996

Presentation

Images courtesy of Children's Hospital, Boston, Massachusetts.

Imaging Findings

Lateral plain film of the skull and coned view of the frontal bone demonstrate bony cortical destruction (arrows) overlying opaque frontal sinuses. A frontal view of the sinuses demonstrates opacification of the maxillary sinus (arrows).

Axial contrast-enhanced CT images demonstrate a soft tissue mass (white arrows) overlying the frontal bone, the opaque frontal sinuses, and two lentiform enhancing areas (black arrows) pressing posteriorly from the eroded frontal bone into the frontal lobes of the brain. This represents an epidural abscess being centrally "tacked down" by the metopic suture.

Coronal sinus CT also demonstrates the opaque maxillary sinus and frontal sinuses (black arrows), as well as bony destruction (white arrows).

Diagnosis

Discussion

The incidence of this complication of sinusitis (most commonly caused by Streptococcus, Haemophilus influenzae, Staphylococcus and Klebsiella) has significantly decreased in the post-antibiotic era. It most often presents between the age of 10 and 20 years. The resultant epidural abscess is thought to be related to the emissary veins that connect the frontal and dural sinuses. Epidural abscess is five times less common than subdural abscess, characteristically shows rim enhancement, and is a surgical emergency. Classically, a subdural abscess can be distinguished from an epidural abscess by its ability to cross sutures, a more cresentic than lentiform appearance, and an inabiltiy to cross the falx.

The patient's bacterial culture grew Streptococcus, and she did well with surgery and 8 weeks of intravenous antibiotics.

References

2. Tudor RB, Carson JP, Pulliam MW, Hill A. Pott's puffy tumor, frontal sinusitis, frontal bone osteomyelitis, and epidural abscess secondary to a wrestling injury. American Journal of Sports Medicine 1981; 9(6):390-1.

• Return to the Teaching Case Database search page
• Return to Professional Education
  
• About BrighamRAD

Dear Visitors: Nothing on this World Wide Web site should be considered medical advice. Only your own doctor can help you make decisions about your medical care. It is not the policy of the Brigham and Women's Hospital Department of Radiology to provide consultation on the World Wide Web or via e-mail. If you have a specific medical question or are seeking medical care, please call the Brigham and Women's Hospital toll-free physician referral line at 1-800-294-9999.

Is this a mirrored page?
The official homepage of the BrighamRAD Teaching Case Database is http://brighamrad.harvard.edu/education/online/tcd/tcd.html