Presentation
History of trauma 5 days ago, presenting with forehead swelling increasing in size and bilateral eyelids edema.
Patient Data
Findings:
An organized heterogeneous collection /abscess is seen in the left forehead soft tissues (subperiosteal abscess) with bone erosion of the anterior and posterior walls (osteomyelitis) of the left frontal sinus with subtle involving the intracranial space with consequent epidural/ subdural lesion 1.1x0.8 cm? empyema suggestive of Pott puffy tumor for clinical correlation and enhanced CT is advised.
The visualized sinuses show evidence of frontal sinus and left ethmoidal sinusitis.
The brain parenchyma shows average attenuation values.
No noticeable parenchymal focal lesions.
No evidence of any intracranial hematoma is seen.
No evidence of midline shift is seen.
Cortical sulci are normal. The ventricles and basal cisterns are normal.
The posterior fossa is unremarkable.
Opinion:
-
The findings mentioned above are highly suggestive of Pott puffy tumor for clinical correlation and enhanced CT brain is advised.
FINDINGS:
Multi-loculated marginally enhanced fluid collection was seen opacifying the left frontal sinus and fronto-ethmoidal recess with an erosion of its anterior and posterior bony outline (osteomyelitis).
A large thick-walled marginally enhanced fluid collection was seen within the frontal scalp measuring about 2 X 4.5 X 4.3 cm in its Ap X T X Ht (subperiosteal abscess).
The left frontal epidural marginally enhanced fluid collection measuring about 1 X 1.8 X 2.5 cm in its APX TX Ht (epidural abscess), indenting the related left frontal lobe.
Mild polypoidal mucosal thickening of both maxillary sinuses.
Normal appearance of both cerebral hemispheres and no masses, areas of abnormal SI or midline shift.
Normal ventricular system. No displacement or deformity.
Normal posterior fossa.
OPINION:·
-
MRI findings are due to acute sinusitis of the left frontal and ethmoidal sinuses complicated with extensions to the extra-cranial subperiosteal abscess and intracranial epidural abscess, Pott puffy tumor.
Case Discussion
A 15-year-old male presented with 5 days history of forehead swelling increasing in size and bilateral eyelids edema. The patient also reported a history of trauma.
CT of the head without contrast was requested and demonstrated opacification of the left ethmoid left frontal sinuses, and frontal subgaleal collection associated with a small left frontal epidural collection.
A subsequent MRI with and without contrast shows sinus opacification with left frontal subgaleal collection and left frontal epidural abscess.
This case represents the most common age group (adolescents), the typical clinical scenario as well as the typical radiological diagnosis of Pott’s puffy tumor with intracranial extension (epidural abscess).
The prompt accurate and quickly diagnosis is made, the prognosis is generally good when proper management is taken of abscess drainage, bone sequestrectomy and broad-spectrum antibiotic use preventing further spreading of the disease and long term sequelae complications .
Case courtesy DR.Moaz Abou Zeid , DR. Enas Taha ,DR Safwat Almoghazi and Dr. Latifa Al-Kandari.