Presentation
Generalized tonic clonic seizures, headache, high grade fever and loss of consciousness.
Patient Data
Hypodense collections with air-fluid levels are seen in the frontal, ethmoidal and maxillary sinuses representing acute sinusitis. There are subgaleal collections with air-fluid levels overlying the frontal and parietal bones consistent with subgaleal abscesses.
There is a subdural collection on the right extending into the parafalcine region and left tentorium suggestive of subdural empyema (though contrast was not given).
Multiple calvarial lesions are seen involving the frontal bones suggesting osteomyelitis.
Case Discussion
CT findings of acute sinusitis, osteomyelitis, subgaleal abscesses and subdural empyema support the diagnosis of pott puffy tumor. The patient underwent surgery for abscess drainage. Culture yielded polymicrobial growth including streptococcus, staphylococcus and peptostreptococcus spp. Culture was negative for acid fast bacilli.