Pott puffy tumor
Recurrent sinusitis. Two week history of forehead fluctuant mass, progressing in size. Now very large, tender, and erythematous. Osteomyelitis?
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There is a heterogenous soft tissue mass with a high attenuation rim overlying the frontal sinuses. Opacification of the frontal sinuses is in keeping with ongoing inflammatory change. Destruction of the underlying frontal bone is in keeping with bony involvement. There is connection through the inner table of the skull to the intracranial soft tissues, where there is a further crescentic anterior frontal extradural collection. Appearances are in keeping with soft tissue infection with osteomyelitis and an empyema.
Surgical samples sent for microscopy, culture, and sensitivity demonstrated the gram positive cocci streptococcus intermedius.
Pott puffy tumor complicates chronic sinus disease and is a less common diagnosis since the advent of antimicrobial treatment.