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Pimiento Figueroa J, Mejia M, Bohorquez D. Pott's Puffy Tumor: A Case Report on Diagnosis Through Imaging. Cureus 2024; 16:e58640. [PMID: 38770497 PMCID: PMC11104277 DOI: 10.7759/cureus.58640] [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] [Accepted: 04/20/2024] [Indexed: 05/22/2024] Open
Abstract
Pott's puffy tumor (PPT) is a rare but life-threatening complication of chronic sinusitis, although it can be secondary to other entities such as trauma or insect bites. It is characterized by circumscribed frontal swelling associated with a subperiosteal abscess. Imaging plays a crucial role in diagnosis and early identification of complications, some of which can be life-threatening, including intracerebral and intra-orbital complications. We present a case of a 14-year-old male with non-specific frontal pain and swelling, where the diagnosis of PTT was confirmed through imaging studies. Upon admission, the patient exhibited orbital and intracerebral complications, as shown in MRI and CT scans. Treatment involved a combination of antibiotics and sinus surgery, with close monitoring for orbital and intracranial complications.
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Affiliation(s)
| | - Marcia Mejia
- Radiology, Universidad de Antioquia, Medellín, COL
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Al Doaibel K, Hasan F, Antar H, Hasan Z, Alfeki S. Frontal Headache and Swelling: A Case Report of Pott's Puffy Tumor. Cureus 2023; 15:e50670. [PMID: 38229811 PMCID: PMC10790809 DOI: 10.7759/cureus.50670] [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] [Accepted: 12/17/2023] [Indexed: 01/18/2024] Open
Abstract
Pott's puffy tumor, a rare complication of frontal sinusitis, poses a diagnostic challenge due to its infrequency and diverse clinical manifestations. Recognizing this condition promptly is crucial due to the potential for severe neurological compromise. We present the case of a 32-year-old male who presented with a one-week history of frontal headache, tenderness, and swelling following an upper respiratory tract infection. The physical examination revealed a tense, erythematous swelling over the frontal region. Laboratory results showed elevated inflammatory markers. Computed tomography revealed an epidural abscess secondary to frontal sinusitis. An emergent craniotomy was performed to evacuate the collection, followed by intravenous antibiotic therapy. The patient recovered with no neurological deficits. This case emphasizes the importance of considering Pott's puffy tumor in patients with frontal swelling and associated symptoms. Despite its rarity, a multidisciplinary approach involving imaging, microbiological analysis, and surgical intervention enables an accurate diagnosis and successful management. Timely recognition and appropriate treatment, including surgical drainage and targeted antibiotics, are critical for achieving favorable outcomes.
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Affiliation(s)
| | - Fatema Hasan
- General Practice, Xi'an Jiaotong University, Xi'an, CHN
| | - Hawra Antar
- General Practice, Wenzhou Medical University, Wenzhou, CHN
| | - Zahra Hasan
- General Practice, National University of Science and Technology, Muscat, OMN
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Rohde RL, North LM, Murray M, Khalili S, Poetker DM. Pott's puffy tumor: A comprehensive review of the literature. Am J Otolaryngol 2022; 43:103529. [PMID: 35700606 DOI: 10.1016/j.amjoto.2022.103529] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 06/06/2022] [Indexed: 11/01/2022]
Abstract
PURPOSE Pott's puffy tumor (PPT) is a rare clinical entity characterized by osteomyelitis of the frontal bone with subperiosteal abscess collection. The frequency of reported cases of PPT in the literature has increased in recent years. Previous reviews of PPT exist primarily in the form of small, retrospective case series and anecdotal case reports. Therefore, the aim of this study is to provide the literature's largest comprehensive, up-to-date review of the essential clinical findings, diagnostic modalities, microbiologic considerations, and treatment approaches utilized in the management of PPT, both in pediatric and adult populations. MATERIALS AND METHODS We searched MEDLINE, PubMed, and Embase databases for English-language studies published from January 1950 through January 30, 2022. The authors reviewed all cases of PPT, focusing specifically on those describing therapeutic management of PPT. A total of 321 patients were included, consisting of 318 patients (from 216 articles) and an additional 3 adult cases from our institution. RESULTS PPT most often results from untreated rhinosinusitis, as well as direct head trauma, substance use, and odontogenic disease. Infections are classically polymicrobial with an anaerobe-predominant microbiome. Both CT and MRI imaging modalities are commonly obtained for presurgical assessment of sinusitis and intracranial extension. The core of treatment is an early and aggressive approach to prevent long-term complications. A significant association exists between surgical management and clinical outcomes for patients with PPT. Recent literature suggests endoscopic sinus surgery is essential for successful disease resolution. CONCLUSIONS PPT is an important and relatively morbid disease process that is often underrecognized and misdiagnosed at presentation due to its variable clinical presentation. Management of PPT includes both antimicrobial therapy and surgical intervention. Determination of the optimal approach depends on patient clinical features including age, history of prior endoscopic sinus surgery, and presence of intracranial involvement on presentation. An individualized, targeted, and interdisciplinary approach to the treatment of PPT is critical for successful disease resolution.
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Affiliation(s)
- Rebecca L Rohde
- Department of Otolaryngology & Communication Sciences, Medical College of Wisconsin, Milwaukee, WI, United States of America; Zablocki Veteran's Association Medical Center, Division of Surgery, Milwaukee, WI, United States of America
| | - Lauren M North
- Department of Otolaryngology & Communication Sciences, Medical College of Wisconsin, Milwaukee, WI, United States of America; Zablocki Veteran's Association Medical Center, Division of Surgery, Milwaukee, WI, United States of America
| | - Molly Murray
- Department of Otolaryngology & Communication Sciences, Medical College of Wisconsin, Milwaukee, WI, United States of America
| | - Sammy Khalili
- Department of Otorhinolaryngology, Aurora Neuroscience Innovation Institute, Aurora St. Luke's Medical Center, Milwaukee, WI, United States of America
| | - David M Poetker
- Department of Otolaryngology & Communication Sciences, Medical College of Wisconsin, Milwaukee, WI, United States of America; Zablocki Veteran's Association Medical Center, Division of Surgery, Milwaukee, WI, United States of America.
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Faridi MMA, Pandey S, Shamsi S. Pott's Puffy Tumor Presenting as Pyogenic Meningitis in an Infant. Case Rep Pediatr 2022; 2022:4732287. [PMID: 35371577 PMCID: PMC8975695 DOI: 10.1155/2022/4732287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 02/10/2022] [Indexed: 02/05/2023] Open
Abstract
Introduction. Pott's puffy tumor is characterized by the osteomyelitis of the frontal bone with underlying subperiosteal abscess, mostly occurring secondary to recurrent sinusitis or head trauma. Though it is a rare clinical entity in this antibiotic era, its occurrence mostly in the adolescent age group has now shown increased reporting lately in all age groups. Case Description. We describe here a case of a 4½-month-old female baby who presented to our hospital's Emergency Room with clinical features of pyogenic meningitis following aspiration of a midline frontal swelling. The infant presented with high-grade fever, 3-4 episodes of projectile vomiting, increased irritability, and refusal to breastfeeding than usual. This was accompanied by a history of a gradually increasing midline fluctuant erythematous swelling on her forehead extending to the left eye. Aspiration of the swelling was done a day before by a local general practitioner, following which she developed the above-mentioned features of pyogenic meningitis and was brought to the hospital the next day. Examination revealed a conscious, febrile, irritable child with bulging anterior fontanel and 101.4°F axillary temperature. Vital signs were within normal limits. CSF analysis was suggestive of pyogenic meningitis, and appropriate antibiotics were given. MRI showed frontal bone osteomyelitis with erosion of the bony plate and focal cerebritis. The condition turned out to be Pott's puffy tumor with pyogenic meningitis after detailed investigations. The infant was treated with appropriate antibiotics and other supportive therapeutic measures and discharged with the advice for further management in collaboration with otorhinolaryngologist.
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Affiliation(s)
- M. M. A. Faridi
- 1Faculty of Medicine, Department of Pediatrics, Era's Lucknow Medical College & Hospital, Lucknow-226003, India
| | - Somya Pandey
- 2Department of Pediatrics, Era's Lucknow Medical College & Hospital, Lucknow-226003, India
| | - Sumaiya Shamsi
- 2Department of Pediatrics, Era's Lucknow Medical College & Hospital, Lucknow-226003, India
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Bofares K, Haqqar Z, Ali I. Pott's puffy tumor: as a very rare and unpredicted complication of ipsilateral pan sinusitis - case presentation and review of articles. RHINOLOGY ONLINE 2021. [DOI: 10.4193/rhinol/21.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Pott's puffy tumor is considered as a rare clinical entity. It is developed as a rare complication of frontal sinusitis. In addition, the trauma to the frontal area is another suggested cause. The Pott's puffy tumor is presented as a forehead swelling due to sub-periosteal collection. Although, the Pott's puffy tumor is a rare condition but at the same time, it can be serious because it may lead to life threatening complications namely, extradural abscess, subdural abscess, meningitis, encephalitis, and brain abscess. Thus, the Pott's puffy tumor is classified as a very significant surgical emergency.
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Song MW, Montovano M, Kubiak A, Khalid S, Ellner J. Pott's Puffy Tumor: Intracranial Extension Not Requiring Neurosurgical Intervention. Cureus 2020; 12:e10106. [PMID: 33005524 PMCID: PMC7522185 DOI: 10.7759/cureus.10106] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Pott’s puffy tumor, typified by a subperiosteal abscess underlying the frontal bone, is an uncommonly encountered clinical entity that can occur in the setting of local trauma or secondary to frontal sinusitis. Diagnosis can be challenging, as cultures may be sterile, and the condition must be differentiated from neoplasm and superficial and soft tissue infection. Although more common in the pediatric population, Pott’s puffy tumor must remain on the differential with a high index of suspicion in adult patients who fit the clinical picture. Early diagnosis with CT or MRI and therapeutic medical and surgical intervention are crucial as intracranial complications, such as abscess and empyema can occur and may be fatal. We present an adult patient with a history of inhaled drug abuse who presented with Pott’s puffy tumor with meningitis and bifrontal epidural abscesses at presentation. There is evidence in the literature that management of sinus-related intracranial epidural abscess with antibiotic therapy and adequate surgical or endoscopic surgical drainage may bypass the need for neurosurgical intervention, as was the case here.
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Affiliation(s)
- Michael W Song
- Infectious Diseases, Rutgers New Jersey Medical School, Newark, USA
| | | | | | - Shaza Khalid
- Infectious Diseases, Rutgers New Jersey Medical School, Newark, USA
| | - Jerrold Ellner
- Infectious Diseases, Rutgers New Jersey Medical School, Newark, USA
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SALOM-COVEÑAS C, BENITO-NAVARRO JR, GUTIÉRREZ-GALLARDO A, PORRAS-ALONSO E. Tumor inflamatorio de pott. Descripción de un caso. REVISTA ORL 2020. [DOI: 10.14201/orl.23019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Hassan S, Rahmani B, Rastatter JC, Jaju AI, Kurup SP. Trauma-associated Pott's puffy tumor: an ophthalmologic perspective. Orbit 2019; 39:38-40. [PMID: 30773962 DOI: 10.1080/01676830.2019.1573909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Pott's puffy tumor is a significant complication of frontal sinusitis that leads to frontal bone osteomyelitis and can be associated with frontal swelling, subperiosteal abscess, and intracranial abscess. It may be associated with antecedent trauma and typically presents in adolescents. Orbital involvement is rarely reported. We describe the case of a 15-year-old male who presented after blunt facial trauma with orbital hematoma and developed Pott's puffy tumor with orbital cellulitis and subperiosteal abscess. Management required a collaborative, multidisciplinary effort that yielded a good outcome.
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Affiliation(s)
- Shahzeb Hassan
- Division of Ophthalmology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.,Department of Ophthalmology, Northwestern University of Ophthalmology Feinberg School of Medicine, Chicago, IL, USA
| | - Bahram Rahmani
- Division of Ophthalmology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.,Department of Ophthalmology, Northwestern University of Ophthalmology Feinberg School of Medicine, Chicago, IL, USA
| | - Jeffrey C Rastatter
- Division of Otolaryngology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Alok I Jaju
- Division of Neuroradiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Sudhi P Kurup
- Division of Ophthalmology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.,Department of Ophthalmology, Northwestern University of Ophthalmology Feinberg School of Medicine, Chicago, IL, USA
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Cannon L, Zwemer E, Stephens JR. Puff laddy: a 5-year-old-boy with forehead swelling. BMJ Case Rep 2017; 2017:bcr-2017-223340. [PMID: 29183902 DOI: 10.1136/bcr-2017-223340] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Laura Cannon
- Department of Pediatrics, UNC Health Care System, Chapel Hill, North Carolina, USA
| | - Eric Zwemer
- Department of Pediatrics, UNC Health Care System, Chapel Hill, North Carolina, USA
| | - John R Stephens
- Department of Pediatrics, UNC Health Care System, Chapel Hill, North Carolina, USA
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Neurosurgical implications of Pott's puffy tumor in children and adolescents. Childs Nerv Syst 2014; 30:1527-34. [PMID: 24996535 DOI: 10.1007/s00381-014-2480-x] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2014] [Accepted: 06/26/2014] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Pott's puffy tumor (PPT) is rare and usually seen as a complication of frontal sinusitis resulting in subperiosteal abscess of the frontal bone with underlying osteomyelitis. PPT is potentially severe and can lead to life-threatening intracranial complications. PATIENTS AND METHODS The authors present a series of six pediatric patients diagnosed with PPT and intracranial complications between 1999 and 2012. There were five boys and one girl, and the mean age at diagnosis was 11.8 years. All patients presented with frontal swelling, headache, and fever. Two patients had lowered level of consciousness and severe hemodynamic instability. RESULTS All patients had epidural abscess, and one also presented subdural empyema. Five patients underwent drainage of all associated abscesses, bone resection, and sinusitis treatment. One was treated conservatively with broad-spectrum antibiotics, and no surgical intervention was required. All patients fully recovered their neurologic status, without further complications.
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Extensive Frontoparietal Abscess: Complication of Frontal Sinusitis (Pott's Puffy Tumor). Case Rep Otolaryngol 2014; 2014:632464. [PMID: 24971185 PMCID: PMC4058198 DOI: 10.1155/2014/632464] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Accepted: 05/01/2014] [Indexed: 11/18/2022] Open
Abstract
First described in 1768, the Pott's puffy tumor is a subperiosteal abscess associated with frontal bone osteomyelitis, resulting from trauma or frontal sinusitis. The classic clinical presentation consists of purulent rhinorrhea, fever, headache, and frontal swelling. The diagnosis is confirmed by CT scan and treatment requires intravenous antibiotics, analgesia, and surgical intervention. Early diagnosis and aggressive medical and surgical approach are essential for a good outcome. It rare and the early diagnosis is important; we describe the case of a 14-year-old adolescent with Pott's puffy tumor who was initially treated inadequately, evolving with extensive frontoparietal abscess. The patient underwent surgical treatment with endoscopic endonasal and external approaches combined. Intravenous antibiotics were prescribed for a prolonged time, with good outcome and remission of the complaints.
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Aínsa Laguna D, Pons Morales S, Muñoz Tormo-Figueres A, Vega Senra M, Otero Reigada M. Tumor inflamatorio de Pott: una complicación infrecuente de la sinusitis frontal. An Pediatr (Barc) 2014; 80:317-20. [DOI: 10.1016/j.anpedi.2013.06.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2013] [Revised: 06/01/2013] [Accepted: 06/03/2013] [Indexed: 11/26/2022] Open
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Rajwani KM, Desai K, Lew-Gor S. Forehead swelling and frontal headache: Pott's puffy tumour. BMJ Case Rep 2014; 2014:bcr-2013-202737. [PMID: 24436286 DOI: 10.1136/bcr-2013-202737] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Stammers D. Case 2: Forehead mass in a teenager. Paediatr Child Health 2013; 18:305-306. [PMID: 24421699 PMCID: PMC3680253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2013] [Indexed: 06/03/2023] Open
Affiliation(s)
- David Stammers
- Correspondence: Dr David Stammers, Room 530, Basic Medical Sciences Building, 745 Bannatyne Avenue, Winnipeg, Manitoba R3E 0J9. Telephone 204-789-3619, fax 204-789-3926, e-mail
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