Pott puffy tumour is a non-neoplastic complication of acute sinusitis characterised by subperiosteal abscess and osteomyelitis, usually related to the frontal sinus but sometimes also related with the mastoid. Forehead swelling is seen, which explains the name of this pathology.
Other rare causes, besides sinusitis, are trauma, intranasal cocaine/methamphetamine abuse and craniotomy.
Although it may affect patients of any age, it has a higher incidence in adolescence. Since the advent of antibiotics, it is infrequently seen.
The infection erodes through the wall of the obstructed infected sinus to form a subperiosteal abscess. As expected it can be associated with extension intracranially with epidural abscess, subdural empyema, meningitis, and cerebral abscess formation. Dural sinus thrombosis is an other possible complication.
The bacteria causing Pott puffy tumour usually reflect the type of bacterial species responsible for community-acquired chronic sinusitis.The most common infective agents implicated are:
- Streptococcus sp
- Haemophilus influenzae
- Staphylococcus sp
CT typically demonstrates an opacified frontal sinus with stranding and swelling of the overlying scalp. Bone algorithm will often demonstrate a defect in the anterior wall of the sinus.
Contrast may demonstrate a focal abscess, and may also allow intracranial complications to be better delineated.
Subtle intracranial involvement is more easily seen at MR imaging. With the injection of gadolinium-based contrast material, one may see early linear enhancement of the dura mater, an extraaxial fluid collection, or an area of cerebritis or focal cerebral abscess formation.
In the scalp, peripheral or rim contrast enhancement may be seen when an organized fluid collection is present.
Treatment and prognosis
Treatment is typically surgical with drainage of the abscess and IV antibiotics (6 to 8 weeks).
History and etymology
It was first described by Sir Percivall Pott (see Pott disease) in 1760.
- inflammatory and infective conditions
- granulomatosis with polyangiitis (Wegener granulomatosis)
- paranasal sinus mucocoele
- silent sinus syndrome
- masses and neoplasms
- fibrous-osseous lesions
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