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Case of the Month

By Dr L F Foo, MBChB, MRCP, FRCR

Answer to Case Of the Month

Findings
There is opacification of the frontal sinus. This is associated with bone destruction of the anterior and posterior walls of the sinus. In close proximity to this area is the superficial soft tissue mass. Intracranially, there is an underlying lentiform extraaxial rim enhancing abnormality which crosses the midline. Extensive filling defects are noted within the superior sagittal sinus.

Apearances are that of a Pott’s puffy tumour (frontal sinusitis, frontal osteomyelitis and subperiosteal abscess), extradural abscess and sagittal sinus thrombosis.
 

Pott’s Puffy Tumour
In 1775, Sir John Percivall Pott described a case of frontal sinusitis causing an indolent, puffy, circumscribed swelling of the forehead. This was subsequently found to be due to subperiosteal abscess formation and underlying osteomyelitis of the frontal bone. This constellation became known as Pott’s puffy tumour.

Early diagnosis and aggressive treatment is essential due to the real risk of intracranial complications requiring urgent medical and surgical intervention. Spread of infection beyond the sinus is either by the haematogenous route (via emissary veins) or direct (via erosions or existing fractures or dehiscence of the sinus walls).

These intracranial complications include meningitis, extradural, subdural and intracerebral abscesses and secondary septic thrombosis of the dural sinuses.

CT with contrast enhancement and use of bony windows provide adequate information with regards the intracranial extent of disease. MRI may also be of value as part of the radiological work up.

Other recognized complications of frontal sinusitis include orbital spread leading to orbital cellulitis, optic neuritis, subperiosteal and intraorbital abscesses.

Treatment of the above patient included intravenous antibiotics and surgical drainage of his extradural haematoma with good results.
 
About the Author 
Dr L F Foo is currently a Radiology trainee in Glasgow, United Kingdom.

 

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Last Updated:
Tuesday, 04 January, 2005