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Kim K, Lee D, Jung S, Chung CH, Chang Y. Pott's puffy tumor of the upper eyelid misdiagnosed as simple abscess: a case report and literature review. Arch Craniofac Surg 2024; 25:141-144. [PMID: 38447589 PMCID: PMC11231407 DOI: 10.7181/acfs.2023.00465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 02/13/2024] [Indexed: 03/08/2024] Open
Abstract
A 76-year-old woman, initially thought to have a simple abscess on her right upper eyelid, presented to our department of plastic and reconstructive surgery. Enhanced three-dimensional facial computed tomography (CT) revealed an abscess on the right upper lid, with a pyomucocele present in the right frontal sinus, accompanied by bone erosion in the superior wall of the right orbit. Based on the results of the CT scan, we diagnosed an atypical Pott's puffy tumor (PPT) with an abscess on the upper lid originating from the frontal sinusitis. First, surgical incision and drainage were performed in our department, and a percutaneous vacuum drain was placed. To provide a more definitive treatment, endoscopic sinus surgery (ESS) was subsequently performed by otorhinolaryngologists. The patient was discharged without any complications 5 days after ESS. At a 1-year follow-up, no recurrence or notable neurological symptoms were observed. In the case we observed, the patient presented with an upper eyelid abscess and cellulitis, indicating possible orbital involvement. For such patients, a CT scan is necessary. Given the possibility of PPT, it is critical to perform a comprehensive differential diagnosis rather than defaulting to a straightforward approach involving abscess treatment.
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Affiliation(s)
- Kuylhee Kim
- Department of Plastic and Reconstructive Surgery, Hallym University Kangdong Sacred Heart Hospital, Seoul, Korea
| | - Donghyun Lee
- Department of Plastic and Reconstructive Surgery, Hallym University Kangdong Sacred Heart Hospital, Seoul, Korea
| | - Soyeon Jung
- Department of Plastic and Reconstructive Surgery, Hallym University Kangdong Sacred Heart Hospital, Seoul, Korea
| | - Chul Hoon Chung
- Department of Plastic and Reconstructive Surgery, Hallym University Kangdong Sacred Heart Hospital, Seoul, Korea
| | - Yongjoon Chang
- Department of Plastic and Reconstructive Surgery, Hallym University Kangdong Sacred Heart Hospital, Seoul, Korea
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Vadiee G, Beshali M, Jahangiri S, Eghlidos Z, Rahimian Z, Mirzaei F. Pott's puffy tumor: A case report. Clin Case Rep 2023; 11:e7815. [PMID: 37854267 PMCID: PMC10580694 DOI: 10.1002/ccr3.7815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 07/05/2023] [Accepted: 07/25/2023] [Indexed: 10/20/2023] Open
Abstract
Key Clinical Message Pott's puffy tumor is a rare condition primarily occurring in the younger population. This report highlights the clinical suspicion and diagnosis of Pott's puffy tumor in those presenting with favorable presentations, especially adolescents. Abstract Pott's puffy tumor (PPT) is characterized as frontal bone subperiosteal abscess and osteomyelitis, a rare condition primarily occurring in adolescents following frontal sinusitis or head trauma. We present a case of atypical PPT in a 12-year-girl following an insect bite. The patient presented with painful forehead swelling for 4 weeks without any history of head trauma or signs of sinusitis. She had a history of a purulent pimple 2 months before presentation, following an insect bite. The primary diagnosis of PPT was made based on clinical and imaging findings. The patient was treated surgically and medically with intravenous antibiotics and had a satisfactory recovery upon the 6-month follow-up visit. This case highlights the differential diagnosis and thorough evaluation for PPT in a child with acute headache and forehead swelling, even without sinusitis symptoms.
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Affiliation(s)
| | - Mohamad Beshali
- Department of Neurosurgery, Faculty of MedicineTabriz University of Medical SciencesTabrizIran
| | - Soodeh Jahangiri
- Endocrine Research Center, Institute of Endocrinology and MetabolismIran University of Medical SciencesTehranIran
| | - Zahra Eghlidos
- Student Research CommitteeShiraz University of Medical SciencesShirazIran
| | - Zahra Rahimian
- Student Research CommitteeShiraz University of Medical SciencesShirazIran
| | - Farhad Mirzaei
- Department of Neurosurgery, Faculty of MedicineTabriz University of Medical SciencesTabrizIran
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Sideris G, Davoutis E, Panagoulis E, Maragkoudakis P, Nikolopoulos T, Delides A. A Systematic Review of Intracranial Complications in Adults with Pott Puffy Tumor over Four Decades. Brain Sci 2023; 13:brainsci13040587. [PMID: 37190552 DOI: 10.3390/brainsci13040587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 03/27/2023] [Accepted: 03/29/2023] [Indexed: 04/03/2023] Open
Abstract
The purpose of this study is to investigate the risk factors of intracranial complications in adult patients with Pott Puffy Tumor (PPT). A systematic review was conducted of clinical studies from January 1983 to December 2022 that reported on PPT adult patients. The full-text articles were reviewed for the patients’ ages, sex, cultured organisms, surgical procedures, clinical sequalae, and underlying diseases that may affect the onset of intracranial complications in PPT adult patients. A total of 106 studies were included. Medical data were reviewed for 125 patients (94 males, 31 females). The median age was 45 years. A total of 52% had comorbidities, mostly head trauma (24.5%), sinus/neurosurgical operations (22.4%), immunosuppression conditions (13.3%), diabetes mellitus (9.1%), cocaine use (7.1%), or dental infections (6.1%). A total of 28 cultures revealed Streptococcus (22.4%), 24 contained staphylococci (19.2%), and 22 cultures contained other pathogens (17.6%). An amount of 30.4% developed intracranial complications, with the most common being epidural abscesses or empyemas (55.3%), as well as subdural (15.7%) and extradural lesions (13.2%). Age, DM, and immunosuppression conditions are significantly associated with intracranial complications (p < 0.001, p = 0.018 and p = 0.022, respectively). Streptococcus infection is associated with intracranial complications (p = 0.001), although Staphylococcus and other microorganisms are not. Surgical intervention, mainly ESS, and broad-spectrum antibiotics remain the cornerstones of treatment.
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Affiliation(s)
- Giorgos Sideris
- 2nd ENT Department, Attikon University Hospital, 124 62 Athens, Greece
| | | | | | | | | | - Alexander Delides
- 2nd ENT Department, Attikon University Hospital, 124 62 Athens, Greece
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4
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Wichtige Differenzialdiagnose bei Gesichtsschwellungen. Monatsschr Kinderheilkd 2022. [DOI: 10.1007/s00112-022-01590-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Bean H, Min Z, Como J, Bhanot N. Pott's puffy tumor caused by Actinomyces naeslundii. IDCases 2020; 22:e00974. [PMID: 33033689 PMCID: PMC7533312 DOI: 10.1016/j.idcr.2020.e00974] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 09/24/2020] [Accepted: 09/24/2020] [Indexed: 11/24/2022] Open
Abstract
Pott’s puffy tumor is characterized by forehead swelling from subperiosteal abscess and frontal bone osteomyelitis. It is encountered mainly in children; rarely in adults. When it does occur in the latter population, the most common risk factors include head trauma, sinusitis, or cocaine abuse. Generally, the organisms thought to be involved include streptococci, staphylococci and oral anaerobic flora. We present a case of a 53 year old female who presented with forehead swelling of 3 month duration after a dental procedure, found to be secondary to Actinomyces naeslundii. Actinomyces is a very rare etiology of this disease and has been reported only twice earlier in the literature. We present an uncommon infectious disease along with summary of clinical characteristics of this entity in the adult population.
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Affiliation(s)
- Holly Bean
- Division of Infectious Disease, Allegheny Health Network, PA, 15212, United States
| | - Zaw Min
- Division of Infectious Disease, Allegheny Health Network, PA, 15212, United States
| | - James Como
- Division of Infectious Disease, Allegheny Health Network, PA, 15212, United States
| | - Nitin Bhanot
- Division of Infectious Disease, Allegheny Health Network, PA, 15212, United States
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6
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Olmaz B, Cingoz M, Akdogan E, Kandemirli SG. Correlation of imaging and intraoperative findings in Pott’s puffy tumour. Scott Med J 2018; 64:25-29. [DOI: 10.1177/0036933018803787] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction Pott’s puffy tumour is characterised by frontal bone osteomyelitis accompanied by subperiosteal abscess. It can be further complicated by intracranial extension of the infectious process. Case presentation A 12-year-old boy initially presented with signs and imaging findings of pan-sinusitis. Despite antibiotic therapy, there was progressive swelling of the forehead region. Subsequent imaging studies revealed osteomyelitis of frontal bone, subcutaneous abscess and extension into intracranial space. The abscesses were surgically drained, and craniectomy for osteomyelitis was carried out. Conclusion The initial symptoms of Pott’s puffy tumour can be subtle, and antibiotic use may mask the underlying sinister involvement of intracranial structures. Imaging plays an important role both in diagnosis and detection of possible intracranial complications.
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Affiliation(s)
- Burak Olmaz
- MD, Department of Neurosurgery, Sirnak State Hospital, Turkey
| | - Mehmet Cingoz
- MD, Department of Radiology, Sirnak State Hospital, Turkey
| | - Emin Akdogan
- MD, Department of Radiology, Sirnak State Hospital, Turkey
| | - Sedat G Kandemirli
- MD, Department of Radiology, Faculty of Medicine, Uludag University, Turkey
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Casado Pellejero J, Lorente Muñoz A, Elenwoke N, Cortés Franco S. Pott's puffy tumor by Actinomyces after minor head trauma. Neurocirugia (Astur) 2018; 30:198-201. [PMID: 30060994 DOI: 10.1016/j.neucir.2018.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 05/30/2018] [Accepted: 06/22/2018] [Indexed: 11/17/2022]
Abstract
Pott's puffy tumour (PPT) is a rare entity that involves scalp swelling associated with subperiosteal abscess and cranial osteomyelitis, occasionally accompanied by intracranial infection. It is usually affiliated with frontal sinusitis, which is a typical but infrequent complication. On the contrary, Osteomyelitis by Actinomyces is rare and usually occurs at the mandibular level, with very few cases of cranial osteomyelitis caused by this bacterial specie, especially after traumatic brain injury. We report an exceptionally unusual case of a PPT frontal tumor after blunt trauma (closed head injury), with an intracranial lesion whereby Actinomyces was isolated after surgery, as a co-participant of the mentioned infection besides Fusobacterium and Propionibacterium.
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Affiliation(s)
| | - Asís Lorente Muñoz
- Servicio de Neurocirugía, Hospital Universitario Miguel Servet, Zaragoza, España
| | - Nnamdi Elenwoke
- Servicio de Neurocirugía, Hospital Universitario Miguel Servet, Zaragoza, España
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8
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Mortazavi MM, Khan MA, Quadri SA, Suriya SS, Fahimdanesh KM, Fard SA, Hassanzadeh T, Taqi MA, Grossman H, Tubbs RS. Cranial Osteomyelitis: A Comprehensive Review of Modern Therapies. World Neurosurg 2018; 111:142-153. [DOI: 10.1016/j.wneu.2017.12.066] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 12/07/2017] [Accepted: 12/09/2017] [Indexed: 11/28/2022]
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9
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Pasin F, Bonardi S, Modoni A. When the diagnosis is written on the forehead. Eur J Intern Med 2018; 47:e1-e2. [PMID: 28483369 DOI: 10.1016/j.ejim.2017.04.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2017] [Accepted: 04/30/2017] [Indexed: 10/19/2022]
Affiliation(s)
- Federico Pasin
- Internal Medicine Unit, Radiological Unit, ASST Cremona, Italy.
| | - Simone Bonardi
- Internal Medicine Unit, Radiological Unit, ASST Cremona, Italy
| | - Antonio Modoni
- Internal Medicine Unit, Radiological Unit, ASST Cremona, Italy
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10
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Şimşek H. Patient presenting with frontal subperiosteal abscess and headache: a case of Pott's puffy tumour. Br J Neurosurg 2017; 33:275-277. [PMID: 28532175 DOI: 10.1080/02688697.2017.1330944] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Chronic sinusitis can be complicated with erosion of anterior or posterior wall of the sinus; causing Pott's puffy tumour in the anterior, or epidural abscess in the posterior communication. A 65-year old man with a painful swelling in his forehead is presented. Pott's puffy tumour was diagnosed. CT, MRI, and DTI studies were obtained. Epidural or dural involvement was not present. In the first operation, anterior wall of the frontal sinus wall was opened. Osteomyelitis debridement was performed and the frontonasal duct was enlarged endoscopically. Antibiotics were commenced and were continued for 6 weeks. In the second operation, nasal septum deviation was fixed. Postoperative course was uneventful. The presented case suggests that treatment of sinus osteomyelitis should comprise immediate surgical drainage and osteomyelitis debridement followed by long-term administration of antibiotics. MRI study with contrast should be obtained to rule out epidural abscess and dural infiltration.
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Affiliation(s)
- Hakan Şimşek
- a Department of Neurosurgery , Gülhane Military Medical Academy, Haydarpaşa Teaching Hospital , Istanbul , Turkey
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11
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Kim YW, Lee DH, Cheon YW. Secondary Reconstruction of Frontal Sinus Fracture. Arch Craniofac Surg 2016; 17:103-110. [PMID: 28913266 PMCID: PMC5556797 DOI: 10.7181/acfs.2016.17.3.103] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2016] [Revised: 05/24/2016] [Accepted: 05/24/2016] [Indexed: 11/11/2022] Open
Abstract
Fractures of frontal sinus account for 5%-12% of all fractures of facial skeleton. Inadequately treated frontal sinus injuries may result in malposition of sinus structures, as well as subsequent distortion of the overlying soft tissue. Such inappropriate treatment can result in aesthetic complaints (contour deformity) as well as medical complications (recurrent sinusitis, mucocele or mucopyocele, osteomyelitis of the frontal bone, meningitis, encephalitis, brain abscess or thrombosis of the cavernous sinus) with potentially fatal outcomes. Frontal contour deformity warrants surgical intervention. Although deformities should be corrected by the deficiency in tissue type, skin and soft tissue correction is considered better choice than bone surgery because of minimal invasiveness. Development of infection in the postoperative period requires all secondary operations to be delayed, pending the resolution of infectious symptoms. The anterior cranial fossa must be isolated from the nasal cavity to prevent infectious complications. Because most of the complications are related to infection, frontal sinus fractures require extensive surgical debridement and adequate restructuring of the anatomy. The authors suggest surgeons to be familiar with various methods of treatment available in the prevention and management of complications following frontal sinus fractures, which is helpful in making the proper decision for secondary frontal sinus fracture surgery.
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Affiliation(s)
- Yang Woo Kim
- Department of Plastic and Reconstructive Surgery, Gachon University Gil Medical Center, Incheon, Korea
| | - Dong Hun Lee
- Department of Plastic and Reconstructive Surgery, Gachon University Gil Medical Center, Incheon, Korea
| | - Young Woo Cheon
- Department of Plastic and Reconstructive Surgery, Gachon University Gil Medical Center, Incheon, Korea
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12
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Abstract
Endocrine-disrupting chemicals (EDCs) are exogenous compounds that have the ability to disrupt the production and actions of hormones through direct or indirect interaction with hormone receptors, thus acting as agonists or antagonists. Human health is affected after either individual occupation or dietary and environmental exposure to EDCs. On the other hand, skin is one of the largest organs of the body and its main function is protection from noxious substances. EDCs perturb the endocrine system, and they are also carcinogenic, immunotoxic, and hepatotoxic to human skin. In addition, their effects on keratinocytes, melanocytes, sebocytes, inflammatory and immunological cells, and skin stem cells produce inflammatory and allergic skin diseases, chloracne, disorders of skin pigmentation, skin cancer, and skin aging. Mechanisms, which EDCs use to induce these skin disorders are complicated, and involve the interference of endogenous hormones and most importantly the activation of the aryl hydrocarbon receptor signal pathway. Further studies on EDCs and skin diseases are necessary to elucidate these mechanisms.
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Affiliation(s)
- Qiang Ju
- Department of Dermatology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Christos C Zouboulis
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Auenweg 38, 06847, Dessau, Germany.
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13
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Tatsumi S, Ri M, Higashi N, Wakayama N, Matsune S, Tosa M. Pott's Puffy Tumor in an Adult: A Case Report and Review of Literature. J NIPPON MED SCH 2016; 83:211-214. [DOI: 10.1272/jnms.83.211] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Satomi Tatsumi
- Department of Dermatology, Nippon Medical School Tama Nagayama Hospital
| | - Min Ri
- Department of Dermatology, Nippon Medical School Tama Nagayama Hospital
| | - Naoyuki Higashi
- Department of Dermatology, Nippon Medical School Tama Nagayama Hospital
| | - Nozomu Wakayama
- Department of Otolaryngology, Nippon Medical School Musashi Kosugi Hospital
| | - Shoji Matsune
- Department of Otolaryngology, Nippon Medical School Musashi Kosugi Hospital
| | - Mamiko Tosa
- Department of Plastic and Reconstructive Surgery, Nippon Medical School Musashi Kosugi Hospital
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14
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Liu A, Powers AK, Whigham AS, Whitlow CT, Shetty AK. A Child With Fever and Swelling of the Forehead. Pott's puffy tumor and epidural abscess complicating frontal sinusitis. Clin Pediatr (Phila) 2015; 54:803-5. [PMID: 25926666 DOI: 10.1177/0009922815584945] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Ann Liu
- Wake Forest School of Medicine, Winston-Salem, NC, USA
| | | | - Amy S Whigham
- Wake Forest School of Medicine, Winston-Salem, NC, USA
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Kim NE, Kim SS. A Case of Pott's Puffy Tumor from Recurrent Upper Eyelid Abscess. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2013. [DOI: 10.3341/jkos.2013.54.5.798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Nam Eok Kim
- Department of Ophthalmology, Maryknoll Medical Center, Busan, Korea
| | - Sang Soo Kim
- Department of Ophthalmology, Maryknoll Medical Center, Busan, Korea
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Sliker CW, Steenburg SD, Archer-Arroyo K. Emergency radiology eponyms: part 1-Pott's puffy tumor to Kerley B lines. Emerg Radiol 2012; 20:103-11. [PMID: 23070255 DOI: 10.1007/s10140-012-1083-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2012] [Accepted: 10/04/2012] [Indexed: 11/25/2022]
Abstract
An eponym is a name based on the name of a person, frequently as a means to honor him/her, and it can be used to concisely communicate or summarize a complex abnormality or injury. However, inappropriate use of an eponym may lead to potentially dangerous miscommunication. Moreover, an eponym may honor the incorrect person or a person who falls into disrepute. Despite their limitations, eponyms are still widespread in medicine. Many commonly used eponyms applied to extremity fractures should be familiar to most emergency radiologists and have been previously reported. Yet, a number of non-extremity eponyms can be encountered in an emergency radiology practice as well. This other group of eponyms encompasses a spectrum of traumatic and non-traumatic pathology. In this first part of a two-part series, the authors discuss a number of non-extremity emergency radiology eponyms, including relevant clinical and imaging features, as well biographical information of the eponyms' namesakes.
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Affiliation(s)
- Clint W Sliker
- Diagnostic Imaging Department, University of Maryland Medical Center, 22 S. Greene Street, Baltimore, MD 21201, USA.
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17
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Parida PK, Surianarayanan G, Ganeshan S, Saxena SK. Pott's puffy tumor in pediatric age group: a retrospective study. Int J Pediatr Otorhinolaryngol 2012; 76:1274-7. [PMID: 22704674 DOI: 10.1016/j.ijporl.2012.05.018] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2012] [Revised: 05/11/2012] [Accepted: 05/15/2012] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To study the etiology, clinical features and treatment outcomes of pediatric Pott's puffy tumor (PPT). METHODS This retrospective study was carried by reviewing medical case record of pediatrics PPT cases admitted to our hospital from January 2010 to august 2011. Data regarding the patient's demographic details, presenting symptoms and signs, etiology, laboratory findings, imaging findings, management, complications and outcomes of treatment were collected and analyzed. RESULTS A total of five cases of PPT were found. Three were male and two were female with a mean age of 11.6 years. All patients presented with headache, fever and tender forehead swelling. Nasal polyps and discharging sinuses over forehead were present in one case and one case had preseptal orbital cellulites in addition to PPT. None of the patient had intracranial complications. Three cases (60%) were secondary to acute frontal sinusitis, one case was as complication of chronic sinusitis and one case was because of trauma. Contrast enhanced Computerized tomography (CECT) demonstrated features of acute sinusitis in 3 cases, sinonasal polyp in one, fracture of anterior table of frontal bone in one case, subperiosteal collection and erosion of anterior table frontal bone in all cases. All patients required surgical intervention; Endoscopic approach 2 cases (40%), combined approach in 2 cases (40%) and external approach in one case (20%) in addition to aggressive antibiotic treatment. There was purulent discharge in frontal sinuses in all cases. In 2 cases (40%), culture of pus drained during surgery was positive; one case methicillin resistant Staphylococcus aureus sensitive to vancomycin, other Pseudomonas aeruginosa sensitive to ceftazidime and amikacin. All cases improved with treatment. There were no postoperative complications or facial cosmetic deformity except facial scar in three cases. The average hospital stay was two weeks and ranged from 10 days to 21 days. All patients received antibiotics for 6-8 weeks to treat osteomyelitis of the frontal bone. The average length of follow up was 9 months (range 6-18 months). All patient are doing well and are under regular follow up. CONCLUSIONS PPT is a complicated infection of frontal sinusitis and trauma that requires broad spectrum antibiotics and surgical treatment. Diagnosis is made by high clinical suspicion of this condition and confirmed by CECT. Early treatment results in favorable outcomes and decreases the risk of further complications.
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Akiyama K, Karaki M, Mori N. Evaluation of adult pott's puffy tumor: Our five cases and 27 literature cases. Laryngoscope 2012; 122:2382-8. [DOI: 10.1002/lary.23490] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2012] [Revised: 04/03/2012] [Accepted: 05/14/2012] [Indexed: 11/08/2022]
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Nisa L, Landis BN, Giger R. Orbital Involvement in Pott's Puffy Tumor: A Systematic Review of Published Cases. Am J Rhinol Allergy 2012; 26:e63-e70. [DOI: 10.2500/ajra.2012.26.3746] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Abstract
BackgroundPott's puffy tumor (PPT) is a frontal subperiosteal abscess associated with underlying frontal bone osteomyelitis. It represents a well-known source of sinogenic intracranial infection, but the orbital complications related to this entity are rarely reported. The goal of this study was to characterize the orbital involvement in PPT.MethodsWe performed a systematic review through a Medline search (1950–2010). The authors reviewed all cases of PPT, selecting those explicitly describing orbital complications associated with PPT.ResultsWe screened 139 articles, of which 93 reported cases of PPT. Of these, 35 articles described a total of 42 cases presenting simultaneous orbital complications. Eyelid and/or periorbital edema was the most common finding in patients with orbital involvement, and preseptal cellulitis is by far the most prevalent orbital complication in PPT. Postseptal involvement (orbital cellulitis, subperiosteal abscess of the orbit, and orbital abscess) is much rarer. Although treatment of the classic PPT is surgical, only a minority of patients with orbital infection required orbital drainage. Most reported patients made a full recovery, without permanent sequelae.ConclusionOrbital infections are possible in patients with PPT. In contrast to surgical treatment of the frontal subperiosteal abscess, the orbital complications can be treated conservatively most of the time. Early diagnosis and aggressive therapy of the underling PPT are essential to avoid severe local or systemic complications.
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Affiliation(s)
- Lluís Nisa
- Department of Otorhinolaryngology–Head and Neck Surgery, Hôpital de Sion, Sion, Switzerland
| | - Basile Nicolas Landis
- Smell and Taste Outpatient Clinic, Department of Otorhinolaryngology–Head and Neck Surgery, Bern University Hospital, Bern, Switzerland
| | - Roland Giger
- Department of Otorhinolaryngology–Head and Neck Surgery, Hôpital de Sion, Sion, Switzerland
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Affiliation(s)
- Hye-Young Kim
- Department of Pediatrics, Medical Research Institute, Pusan National University College of Medicine, Busan, Korea
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The Pott’s puffy tumor: a dangerous sign for intracranial complications. Eur Arch Otorhinolaryngol 2011; 268:1755-63. [DOI: 10.1007/s00405-011-1660-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2011] [Accepted: 05/25/2011] [Indexed: 10/18/2022]
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Gupta S, Vachhrajani S, Kulkarni AV, Taylor MD, Dirks P, Drake JM, Rutka JT. Neurosurgical management of extraaxial central nervous system infections in children. J Neurosurg Pediatr 2011; 7:441-51. [PMID: 21529183 DOI: 10.3171/2011.2.peds09500] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Extraaxial infections of the CNS, including subdural empyema and epidural abscess, are rare but potentially life-threatening conditions. Symptoms are usually progressive, and early diagnosis is therefore important. Early intervention with appropriate treatment offers the best opportunity for eradicating the infection and promoting maximal neurological recovery. METHODS The medical records of children with extraaxial CNS infection over the last 24 years at the Hospital for Sick Children were analyzed. Only those patients with radiological and/or operative confirmation of the diagnosis of subdural empyema or epidural abscess were included in the study. Demographic and clinical data were collected to determine the outcomes after such infections and factors that predict for such outcomes. RESULTS The authors identified 70 children who fulfilled the inclusion criteria. Sinusitis was the most common etiology and was seen in 38 patients. All of these patients were older than 7 years of age at diagnosis. Subdural empyemas were diagnosed in 13 patients following bacterial meningitis, and they were found primarily in infants within the 1st year of life. Other etiological factors included otogenic infection (4 cases), postneurosurgical infection (7 cases), and hematogenous spread of infection (7 cases including 6 cases of spinal epidural abscess). Streptococcus anginosus and Staphylococcus aureus were the most common pathogens identified. Sixty-four patients (91.4%) underwent at least 1 neurosurgical procedure. Seizures and cerebral edema from cortical vein thrombosis were the most common complications. CONCLUSIONS Due to variable etiology, identification of the responsible microorganism through neurosurgical drainage followed by long-term intravenous antibiotics remains the mainstay in treating extraaxial CNS infections. Optimal outcome is achieved with early diagnosis and therapy.
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Affiliation(s)
- Sanjay Gupta
- Division of Neurosurgery, The Hospital for Sick Children, The University of Toronto, Ontario, Canada
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Endoscopic Endonasal Treatment of a Pott's Puffy Tumor. Clin Exp Otorhinolaryngol 2011; 5:112-5. [PMID: 22737293 PMCID: PMC3380111 DOI: 10.3342/ceo.2012.5.2.112] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2009] [Revised: 11/17/2009] [Accepted: 12/03/2009] [Indexed: 11/08/2022] Open
Abstract
Pott's puffy tumor is an infrequent entity characterized by a subperiosteal abscess associated with frontal bone osteomyelitis. It has become rare due to the development of antibiotics and is usually seen as a complication of frontal sinusitis. Although Pott's puffy tumor is more commonly described in children, it should also be included in the differential diagnosis of swelling on the forehead in adults. Once the diagnosis is suspected, appropriate imaging should be performed to evaluate the possible complications. The treatment of Pott's puffy tumor combines medical and surgical approaches in order to prevent further complications. The goal of surgery is to drain the sinus and to excise the infected bone if necessary. The endoscopic endonasal approach is a safe and effective alternative to the external approach. This report describes the case of a 25-year-old man with Pott's puffy tumor resulting from frontal sinusitis.
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Affiliation(s)
- Russell E Bartt
- Deparment of Neurological Sciences, Cook Country Hospital, Rush Medical College, Chicago, IL 60612, USA.
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Tsai BY, Lin KL, Lin TY, Chiu CH, Lee WJ, Hsia SH, Wu CT, Wang HS. Pott's puffy tumor in children. Childs Nerv Syst 2010; 26:53-60. [PMID: 19727764 DOI: 10.1007/s00381-009-0954-z] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2009] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Pott's puffy tumor is characterized by subperiosteal abscess associated with osteomyelitis of frontal bone. Reports are limited for this rare entity in the antibiotics era but increase during past decade. METHODS We had clinical analysis of a series with six consecutive pediatric patients of Pott's puffy tumor during 20 years in a tertiary medical center via retrospective chart review. One case was described in detail. RESULTS Male-to-female ratio was 5:1. The mean age at the time of diagnosis was 13 years-3 months. The risk factors were acute sinusitis in two (33%), chronic sinusitis in two (33%), recent head trauma in two (33%), and acupuncture therapy on skull in one (17%). The commonest presenting symptoms were fever, headache, forehead tenderness, vomiting, and fatigue/malaise (100%). Pott's puffy tumor was diagnosed on average the seventh day after fever, and half had intracranial involvement at diagnosis. All had intracranial infections, and most of them had subdural empyema. The most often involved sinus was frontal sinus (100%). The frontal lobe was the most common site of intracranial infection (100%), two thirds of which are polymicrobial from two or more sites. The initial operation was performed on average on the 5.8th days after diagnosis. Half of the patients underwent reoperation. The mortality rate was 17% (one of six). CONCLUSION The symptoms of Pott's puffy tumor are inconspicuous even though early intracranial involvement often occurred. The importance of early diagnosis and aggravated and prompt treatment with prolonged antibiotic therapy is emphasized for better outcome.
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Affiliation(s)
- Bih-Yu Tsai
- Division of Pediatric Neurology, Chang Gung University College of Medicine, Taoyuan, Taiwan
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26
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Wu CT, Huang JL, Hsia SH, Lee HY, Lin JJ. Pott's puffy tumor after acupuncture therapy. Eur J Pediatr 2009; 168:1147-9. [PMID: 19057925 DOI: 10.1007/s00431-008-0892-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2008] [Accepted: 11/25/2008] [Indexed: 11/30/2022]
Abstract
We report a case of Pott's puffy tumor (PPT) with Pseudomonas infection occurring after acupuncture therapy in a ventilator-dependent child. Acupuncture use has been growing during the past decade in the whole world. Infectious complications range from benign to lethal. PPT is a subperiosteal abscess of the frontal bone associated with underlying osteomyelitis. It presents as a localised swelling of the forehead. This paper describes a 12-year-old girl with PPT. To our knowledge, this is the first case report of PTT caused by acupuncture therapy.
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Affiliation(s)
- Chang-Teng Wu
- Department of Pediatrics, Children Medical Center, Chang Gung Memorial Hospital, 5 Fu-Shing Street, Kweishan 333, Taoyuan, Taiwan, Republic of China.
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Forgie SE, Marrie TJ. Pott's puffy tumor. Am J Med 2008; 121:1041-2. [PMID: 19028195 DOI: 10.1016/j.amjmed.2008.08.018] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2008] [Revised: 08/05/2008] [Accepted: 08/06/2008] [Indexed: 10/21/2022]
Affiliation(s)
- Sarah E Forgie
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.
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Betz CS, Issing W, Matschke J, Kremer A, Uhl E, Leunig A. Complications of acute frontal sinusitis: a retrospective study. Eur Arch Otorhinolaryngol 2007; 265:63-72. [PMID: 17676328 DOI: 10.1007/s00405-007-0411-0] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2007] [Accepted: 07/17/2007] [Indexed: 12/01/2022]
Abstract
Even though being a rare condition in the era of antibiotic treatment, complications of acute frontal sinusitis still pose a potentially life-threatening problem. We present a clinical case series using a combined surgical approach. Within a 7 year period, all patients with a suppurative complication of an acute frontal sinusitis were included into this retrospective study and evaluated concerning histories, diagnostic and therapeutic procedures and achieved outcomes. Twelve patients (11-74 years) were identified; this corresponds to 0.3% of all patients that have undergone paranasal sinus surgery and 15.4% of all patients with infectious complications of sinusitis. The cases could be subdivided as follows: intracranial complications (4/12), osteomyelitis of the frontal bone (4/12), frontal/orbital soft tissue involvement (3/12) and endoluminal empyema (1/12). These were all correctly diagnosed by CT and (especially in the cases of intracranial complications) MRI. The microbiological spectrum comprised mostly non-multiresistant Staphylococci and Streptococci. All patients received aggressive antibiotic and combined surgical treatment. Within a mean follow up period of 32 months, the disease-related mortality and the rate of severe long-term ailment was 0%. If detected and treated early, both long-term morbidity and mortality can be minimised. A close cooperation with the related specialties (neurosurgery, ophthalmology, radiology) is thereby of utmost importance.
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Affiliation(s)
- Christian S Betz
- Department of Otorhinolaryngology, Head and Neck Surgery, Ludwig Maximilian University, Munich, Germany
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Hayek BR, Sitole S, Andreoli M, Banich A, Ahmad AZ. Bilateral Eyelid Edema and Orbital Cellulitis Associated With Pott's Puffy Tumor. Ophthalmic Plast Reconstr Surg 2007; 23:163-5. [PMID: 17413642 DOI: 10.1097/iop.0b013e31803316b5] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Pott's puffy tumor is rarely associated with orbital cellulitis. We describe a pediatric patient with Pott's puffy tumor and right-sided orbital cellulitis. He underwent urgent surgical drainage of a glabellar subperiosteal abscess and completed a six week course of intravenous antibiotics with complete resolution of infection and no long-term sequelae. Close monitoring with imaging for intracranial spread and multidisciplinary surgical intervention are commonly recommended.
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Affiliation(s)
- Brent R Hayek
- Section of Ophthalmic Plastic and Reconstructive Surgery, Department of Ophthalmology, Loyola University Medical Center, Chicago, Illinois 60153, USA
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30
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Chain JR, Kingdom TT. Non-Hodgkin's lymphoma of the frontal sinus presenting as osteomyelitis. Am J Otolaryngol 2007; 28:42-5. [PMID: 17162131 DOI: 10.1016/j.amjoto.2006.06.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2006] [Indexed: 01/04/2023]
Abstract
OBJECTIVES The aim of the study was to present a case of non-Hodgkin's lymphoma (NHL) originating in the frontal sinus that presented as osteomyelitis of the frontal bone. METHODS A review of a single case including radiographic, intraoperative, and pathologic findings was done, followed by a discussion highlighting relevant literature. RESULTS A 55-year-old man presented with pain and swelling of the forehead with 8 weeks duration. He had a history of chronic rhinosinusitis and underwent endoscopic maxillary antrostomies 4 years prior. A presumptive diagnosis of frontal sinusitis with osteomyelitis was made and prolonged oral antibiotic therapy started. The patient was referred to our center after symptoms and objective findings failed to improve. Computed tomography revealed a destructive process of the frontal bone with near total opacification of the frontal sinuses. An exploratory external frontal sinusotomy was performed revealing an infiltrative soft tissue mass filling most of the frontal sinus. Dehiscence of the posterior table was noted without dural involvement. Pathology of this mass revealed diffuse large B-cell lymphoma of intermediate grade. The patient underwent 6 cycles of chemotherapy with cyclophosphamide, doxorubicin, vincristine, and prednisone; radiotherapy to the frontal bone; and central nervous system prophylaxis via intrathecal methotrexate. Clinically, he fell into the Ann Arbor Stage II EA NHL category because of an isolated axillary lymph node. Now, 18 months after completion of therapy he is without evidence of disease based on serial positron emission tomography and computed tomography scanning. CONCLUSIONS We describe a case of NHL of the frontal sinus, which presented as osteomyelitis. We highlight important features of this patient's clinical presentation that can help differentiate an inflammatory process from a neoplastic process in the frontal bone. Timely diagnosis is critical, and neoplasms of the frontal sinus can be easily misdiagnosed as inflammatory.
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Affiliation(s)
- Jeffrey R Chain
- Department of Otolaryngology, University of Colorado Health Sciences Center, Denver, CO, USA
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Davidson L, McComb JG. Epidural-cutaneous fistula in association with the Pott puffy tumor in an adolescent. Case report. J Neurosurg 2006; 105:235-7. [PMID: 16970240 DOI: 10.3171/ped.2006.105.3.235] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The Pott puffy tumor is a subperiosteal abscess associated with underlying osteomyelitis, most often of the frontal bone in conjunction with frontal sinusitis. Intracranial sequelae can include epidural abscess, subdural empyema, intraparenchymal abscess, meningitis, and dural venous thrombophlebitis, all with resultant neurological deterioration. Although once common, this entity has become rare since the introduction of antibiotic agents. The authors present an unusual case of a 14-year-old girl suffering from the Pott puffy tumor whose condition was further complicated by a draining epidural-cutaneous fistula and an epidural abscess.
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Affiliation(s)
- Laurence Davidson
- Department of Neurosurgery, University of Southern California Keck School of Medicine, Los Angeles, California 90033, USA.
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Romero N, Luque R, Haro JL, Frutos M. [Posterior cervical mass following aseptic meningitis]. Enferm Infecc Microbiol Clin 2005; 23:451-2. [PMID: 16159546 DOI: 10.1157/13078805] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- Nieves Romero
- Servicio de Cardiología, Hospital Universitario Virgen del Rocío, Sevilla, España.
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Evliyaoğlu C, Bademci G, Yucel E, Keskil S. Pott's puffy tumor of the vertex years after trauma in a diabetic patient: case report. Neurocirugia (Astur) 2005; 16:54-7. [PMID: 15756412 DOI: 10.1016/s1130-1473(05)70435-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Pott's puffy tumor is a rare clinical entity characterized by subperiosteal abscess associated with osteomyelitis. It is usually seen as a complication of frontal sinusitis or trauma. This is the unique report of a Pott's puffy tumor located over the vertex of a type 1 diabetic patient with an unusual latency of 14 years following injury. A 27-year old man presented with pain and a soft swelling on his vertex. Magnetic resonance imaging demonstrated subperiosteal abscess in the vertex region associated with dural thickening and perisinusal irregularities of epidural space. Further history revealed that he had a trauma to the same location when he was 13 years old. Considering possible complications due to proximity of the lesion to the sagittal sinus, we retrained from aggressive surgical interventions. We treated our patient with a simple surgical abscess drainage followed by prolonged use of antibiotics and achieved complete therapy. The cellular and humoral elements of the immune system may be disrupted in diabetic patients resulting in such atypical courses and complications of infections. We want to emphasize both importance of the prompt diagnosis of Pott's puffy tumor as intracranial invasion may cause severe neurologic problems, and importance of a surgical intervention tailored for the individual lesion.
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Affiliation(s)
- C Evliyaoğlu
- Department of Neurosurgery, Kirikkale University School of Medicine, Kirikkale, Turkey
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