Presentation
Right frontal swelling with neurological deficit to rule out cerebral focal lesion.
Patient Data
There is evidence of expansile fluid filling the frontal sinuses with extension into the ethmoidal sinuses, and superior intracranial extension occupying the extra-axial compartment causing mass effect on the frontal lobes bilaterally more on the right side. Post-contrast images show peripheral and multiple curvilinear enhancement suggesting infected process ( large abscess ) of the frontal sinuses mainly extending to the ethmoidal sinuses.
The aforementioned space-occupying lesion contains some blood and air. This kind of rather aggressive infection could be due to fungal infection.
There may be bony erosion between the anterior cranial foci and the frontal sinus which needs to be evaluated by CT scan.
Mucosal thickening of maxillary antra is also seen.
Unremarkable orbital intra and extra conal spaces bilaterally.
There is no evidence of intra-axial involvement and both lateral ventricles appear normal in size, shape, and position.
Case Discussion
This is an uncommon disease faced nowadays. Pott puffy tumor primarily presents a complication of acute sinusitis which is usually related to the frontal sinuses. It is characterized by subgaleal collection, subperiosteal abscess, and osteomyelitis.
He was treated successfully by surgical drainage and antibiotics. Culture revealed Staphylococcus epidermidis.