Pott’s puffy tumor

A 36-year-old male presented with headache, high grade fever and a swelling on his forehead for five days. On examination a warm, tender swelling was seen on the forehead (Figure 1). The CT scan revealed a collection in the frontal sinus associated with erosion of the anterior wall of the frontal sinus (Figure 2). A diagnosis of Pott’s puffy tumor was made and the pus drained endoscopically through the nose. The patient was given intravenous broad spectrum antibiotics for six weeks and the symptoms resolved completely. The patient is asymptomatic at six months of follow-up. Pott’s puffy tumor, first described by the surgeon Sir Percivall Pott, is a frontal osteomyelitis with associated subperiosteal abscess of the frontal bone.1 It is most commonly due to frontal sinusitis. Presentation includes headache, fever, periorbital or scalp swelling. Involvement of the posterior table of the sinus can lead to intracranial extension manifesting either as epidural abscess, subdural empyema or meningitis, involvement inferiorly can lead to orbital manifestations such as cellulitis or abscess.1 Sinus cultures are often polymicrobial and intravenous antibiotics are given for six to eight weeks. The drainage can be carried out through endoscopic sinus surgery.1

Figure 1: Patient with a frontal swelling [Arrow].

Figure 2: CT scan showing a collection in the frontal sinus associated with erosion of its anterior wall [Arrow].  

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