Baylor University Medical Center Proceedings April 2017 - 179

Pott puffy tumor
Pranav Sharma, MD, Salil Sharma, MD, Nishant Gupta, MD, Puneet Kochar, MD, and Yogesh Kumar, MD

Pott puffy tumor is osteomyelitis of the
frontal bone with associated subperiosteal
abscess causing swelling and edema over
the forehead and scalp. It is a complication of frontal sinusitis or trauma. We
present the case of an 8-year-old girl
with frontal swelling. Imaging evaluation
showed frontal osteomyelitis as a complication of frontal sinusitis with associated
epidural and subperiosteal abscess. The
patient was treated surgically and recovered well. This case highlights the need
for high clinical suspicion and early diagFigure 1. Sagittal CT of the brain with (a) bone window and (b) soft tissue window images shows erosion of the
nosis and management to prevent life- outer and inner cortices of frontal bone (arrow) with prefrontal soft tissue swelling (arrow).
threatening complications. Unfortunately,
in our case the patient had to undergo surgery for this complication,
and underwent craniotomy with trephination and drainage of
the brain abscess. Functional endoscopic sinus surgery with a
which could have been prevented by earlier diagnosis.

ott puffy tumor is a rare complication of sinusitis
characterized by osteomyelitis of the frontal bone with
subperiosteal abscess presenting as frontal swelling. It
was ﬁrst described by Sir Percival Pott in 1768 in relation to frontal head trauma. Later, it was established that this
entity is more common in relation to frontal sinusitis (1). We
report a case of an 8-year-old girl who presented with gradually
increasing frontal swelling.
CASE REPORT
An 8-year-old girl was referred for persistent headaches
and gradually increasing frontal swelling for 3 days. She had
sinusitis 1 month earlier and was treated with azithromycin.
She had multiple drug allergies to penicillin, cephalosporin,
and cotrimoxazole. A computed tomography (CT) scan revealed frontal sinusitis with cortical erosions and frontal subperiosteal and epidural soft tissue swelling (Figure 1). Magnetic
resonance imaging (MRI) revealed frontal sinusitis, frontal
bone defect, and frontal epidural collection with peripheral
rim enhancement suggestive of epidural abscess (Figure 2).
A small subperiosteal abscess was also noted in the frontal
soft tissues. The patient was started on intravenous antibiotics
Proc (Bayl Univ Med Cent) 2017;30(2):179-181

left ethmoidectomy and frontal and maxillary antrostomy was
also performed. Culture of the pus revealed Streptococcus intermedius. The follow-up MRI revealed resolution of subperiosteal
and epidural abscesses (Figure 3).
DISCUSSION
Pott puﬀy tumor is a rare clinical entity with the advancement in antibiotic treatment. Initially described with head
trauma, now it is known to be associated with untreated or
partially treated sinusitis; however, cases due to mastoid surgery,
dental infections, wrestling injuries, and insect bites have been
reported (2, 3). Pott puﬀy tumor can be found in all age groups,
but occurs predominantly in adolescents (4). Frontal sinuses
are often pneumatized by 2 years of age and are approximate
adult size by the late teens. Venous drainage occurs through
diploic veins that have communication with the dural venous
sinuses, which can propagate septic emboli (4). These infections
From the Department of Radiology, Yale New Haven Health at Bridgeport Hospital,
Bridgeport, Connecticut (P. Sharma, S. Sharma, Kochar, Kumar); and the Department
of Radiology, St. Vincent's Medical Center, Bridgeport, Connecticut (Gupta).
Corresponding author: Yogesh Kumar, MD, Department of Radiology, Yale New
Haven Health at Bridgeport Hospital, 267 Grant Street, Bridgeport, CT 06610
(e-mail: yogeshkumar102@gmail.com).
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