Potts puffy tumour: a rare but important diagnosis

Abstract

Potts puffy tumour (PPT) is a subperiosteal abscess arising from frontal bone osteomyelitis. We present a case of a 75-year-old lady with headache and a forehead swelling who was initially treated for sinusitis and giant cell arteritis in a primary care setting, but failed to improve. Following clinical deterioration and further investigation, CT appearances were consistent with a diagnosis of PPT and an extra-axial collection. Needle decompression, frontal trephine and endoscopic frontal sinusotomy were performed and intraoperative swabs cultured Streptococcus constellatus PPT is an unusual clinical entity that benefits from prompt antibiotic and surgical management, and therefore early recognition is paramount. We highlight that PPT should be a differential diagnosis in all patients presenting with forehead or frontal swelling. Use of radiological imaging (CT/MRI) is necessary to not only confirm a diagnosis of PPT but to identify further intracranial complications, which can be life-threatening.

Pott’s Puffy Tumor with Intracranial Extension in a Minimally Symptomatic Adolescent

“…Intracranial infections additionally may contain anaerobic organisms [18]. Pathogens that have infrequently been cultured include Enterococcus, Pseudomonas, E. coli, P. multocida and S. constellatus [2,11]. The culture in this case grew a combination of Staphylococcus aureus and Klebsiella sp.…”

“…In the case described, a combination approach was utilized because of the need to address intracranial involvement. Patients are also given broad spectrum antimicrobials over a 6-8 weeks period in order to address the frontal bone osteomyelitis and prevent a relapse [2,9]. Once appropriately managed, full recovery can be expected.…”

“…Pott's puffy tumor has been infrequently reported since the widespread use of antibiotics for head and neck infections [1,2]. As a result, it is not a common differential diagnosis for frontal headaches and a high suspicion has to be maintained in order to diagnose and treat the condition.…”

Case Report: Pott's Edematous Tumor: Complicated Frontal Sinusitis - An Unremembered Diagnosis

“…PET is usually an extracranial complication of frontal sinusitis and is characterized as subperiosteal abscess of the anterior wall of the frontal sinus, associated with osteomyelitis of the frontal bone. It was first described by Sir Percival Pott, as a consequence of head trauma (1), however, it is known that currently the main causes are rhinosinusitis, acute or chronic, underdiagnosed or inadequately treated (2)(3)(4). PET may still be associated with other conditions such as drug use, infections and frontal surgeries (2).…”

Pott Puffy Tumor Caused by Dental Infection: A Case Report and Literature Review

“…Accordingly, violence and firearm injuries are common in the capital Mogadishu, which is the most populated city in Africa with 2.2 million inhabitants. 2 The death rate due to current civil aggression, conflicts, and terrorist attacks in Somalia is 4.1%, 3 and the life expectancy is 52 years. 4 In Somalia, 22.2% of facial fractures are caused by firearm injuries.…”