Presentation
Fever, headache , seizures and focal neurological deficits.
Patient Data
There are T1 hypointense and T2 hyperintense collections in the right frontal, sphenoid and ethmoidal sinuses. It shows peripheral enhancement post gadolinium administration and diffusion restriction on diffusion weighted images indicative of an infective process/abscess collections. Extension into the soft tissue overlying the right frontal bone (subgaleal abscess). There is marrow edema in the adjacent right frontal bone suggestive of osteomyelitis (which will be better delineated on CT).
Intracranial extension in the form of multiple cerebral abscesses with extensive vasogenic in the right frontal lobe, largest measures 74 x 63 x 46 mm. Associated effacement of the surrounding sulci, gyri, lateral and third ventricles. Significant midline shift of 26 mm to the left is noted.
Case Discussion
Pott puffy tumor is a non-neoplastic complication of acute sinusitis characterized by subgaleal collection, subperiosteal abscess and osteomyelitis. There may be intracranial extension with epidural abscess, subdural abscess, meningitis and cerebral abscess formation.
MRI findings in this child is consistent with pott puffy tumor with cerebral abscesses which was surgically drained. Culture yielded no bacteria growth likely due to previously administered antibiotics. Culture also yielded no fungal growth or acid fast bacilli.
Additional contributor: Dr Hammed Oshola, Neurosurgeon.
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