Pott puffy tumor and cerebral abscess

Case contributed by Khalid Alhusseiny
Diagnosis certain


One month history of progressive headache with new onset of facial and scalp swelling.

Patient Data

Age: 20 years
Gender: Male

There is a well-defined left frontal lobe intra-axial space occupying lesion with associated edema and subsequent mass effect in the form of compression of the ipsilateral frontal horn of the lateral ventricle and shift of the midline toward the right side.

The center of the left frontal lobe lesion displays high signal intensity (SI) on T2, intermediate SI on FLAIR and low SI on T1 as well as high SI on DWI with corresponding low ADC map denoting restricted diffusion. The periphery of the lesion is of low SI on T2 and post-contrast ring enhancement. Perfusion images show that the lesion and associated edema are hypoperfused. The posterior wall of the lesion shows a focal defect with a focal cerebral enhancing nodule. The findings are keeping with cerebral abscess.

Fronto-parietal pachymeningeal thickening and enhancement as well as extra-axial collections with marginal enhancement and restricted diffusion are seen in keeping with extra-axial empyema. The superior sagittal sinus is attenuated.

There is mucosal thickening and enhancement of the anterior ethmoidal and frontal paranasal sinuses. Milder mucosal thickening is seen involving both maxillary sinuses.

There is abnormal post-contrast enhancement of the frontal bone.

Significant soft tissue thickening, hyperperfusion and post-contrast enhancement are seen involving the nose, forehead and scalp with multiple subgaleal collections with marginal enhancement and restricted diffusion in keeping with multiple abscesses.

CT images revealed lytic permeative bony destruction of the frontal bone mainly along its left aspect and extending from the fronto-nasal sutures caudally till the coronal suture cranially.

The previously described intra-cranial and extra-cranial MRI findings are also seen.

Earlier MRI ~ 1 month ago


Images from MRI study of the brain that was done at the initial presentation of the patient showing ethmoidal and to a lesser extent frontal and right maxillary sinusitis as well as small retention cyst at the left maxillary sinus.

Case Discussion

The case nicely represents findings seen in Pott puffy tumor; a non-neoplastic complication of acute sinusitis.

There was a progression of the paranasal sinusitis that was seen on the first MRI study of the brain in the form of frontal bone destruction that lead to extra-cranial and intra-cranial extension of the infection with development of multiple subgaleal abscesses, skull osteomyelitis, extra-axial empyema and left frontal lobe abscess.

How to use cases

You can use Radiopaedia cases in a variety of ways to help you learn and teach.

Creating your own cases is easy.

Updating… Please wait.

 Unable to process the form. Check for errors and try again.

 Thank you for updating your details.