Pott's puffy tumour

Pott"s

puffy tumor, spreading towards patients" brain. MRI, T1, sagittal, gadolinium contrast

Teenager with

left orbital and forehead swelling. Sagittal CT with contrast of the brain shows frontal and left maxillary sinusitis and extensive soft tissue swelling anterior to the forehead (upper left) and destruction of the anterior left frontal bone in the frontal sinus and extensive soft tissue swelling anterior to the left orbit (upper right). Coronal (lower left) and sagittal (lower right) T1 MRI with contrast of the brain shows diffuse meningeal enhancement, subdural empyemas along the falx and both cerebral convexities, and multiple large non-enhancing subgaleal fluid collections in the left scalp.The diagnosis was meningitis, subdural empyema, and Pott puffy tumor as complications of sinusitis.

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Pott puffy

tumor • Pott puffy tumor - Ganzer Fall bei Radiopaedia

Radswiki T, Pott puffy tumor. Case study, Radiopaedia.org (Accessed on 12 Dec 2022) https://doi.org/10.53347/rID-11815 • CC by-nc-sa 3.0 (modified)

Pott puffy

tumor • Pott puffy tumor - Ganzer Fall bei Radiopaedia

Wang M, Pott puffy tumor. Case study, Radiopaedia.org (Accessed on 12 Dec 2022) https://doi.org/10.53347/rID-13926 • CC by-nc-sa 3.0 (modified)

Osteomyelitis

• Pott puffy tumor - Ganzer Fall bei Radiopaedia

Gaillard, F. Pott puffy tumor. Case study, Radiopaedia.org. (accessed on 23 Oct 2022) https://doi.org/10.53347/rID-4893 • CC by-nc-sa 3.0 (modified)

Pott puffy

tumor • Skull osteomyelitis - Pott puffy tumor - Ganzer Fall bei Radiopaedia

Di Muzio B, Skull osteomyelitis - Pott puffy tumor. Case study, Radiopaedia.org (Accessed on 12 Dec 2022) https://doi.org/10.53347/rID-21567 • CC by-nc-sa 3.0 (modified)

Pott puffy

tumor • Pott puffy tumor - Ganzer Fall bei Radiopaedia

Gaillard F, Pott puffy tumor. Case study, Radiopaedia.org (Accessed on 12 Dec 2022) https://doi.org/10.53347/rID-8170 • CC by-nc-sa 3.0 (modified)

Pott puffy

tumor • Pott puffy tumor - Ganzer Fall bei Radiopaedia

Ibrahim D, Pott puffy tumor. Case study, Radiopaedia.org (Accessed on 12 Dec 2022) https://doi.org/10.53347/rID-56151 • CC by-nc-sa 3.0 (modified)

Pott puffy

tumor • Pott puffy tumor - Ganzer Fall bei Radiopaedia

Di Muzio B, Pott puffy tumor. Case study, Radiopaedia.org (Accessed on 12 Dec 2022) https://doi.org/10.53347/rID-56217 • CC by-nc-sa 3.0 (modified)

Pott puffy

tumor • Pott puffy tumor - Ganzer Fall bei Radiopaedia

Thurston M, Pott puffy tumor. Case study, Radiopaedia.org (Accessed on 12 Dec 2022) https://doi.org/10.53347/rID-59019 • CC by-nc-sa 3.0 (modified)

Pott puffy

tumor • Pott puffy tumor - Ganzer Fall bei Radiopaedia

Hartung M, Pott puffy tumor. Case study, Radiopaedia.org (Accessed on 12 Dec 2022) https://doi.org/10.53347/rID-74817 • CC by-nc-sa 3.0 (modified)

Subdural

empyema • Pott puffy tumor and cerebral abscess - Ganzer Fall bei Radiopaedia

Alhusseiny, K. Pott puffy tumor and cerebral abscess. Case study, Radiopaedia.org. (accessed on 20 Oct 2022) https://doi.org/10.53347/rID-85002 • CC by-nc-sa 3.0 (modified)

Pott puffy

tumor • Pott puffy tumor - Ganzer Fall bei Radiopaedia

Qaqish N, Pott puffy tumor. Case study, Radiopaedia.org (Accessed on 12 Dec 2022) https://doi.org/10.53347/rID-85887 • CC by-nc-sa 3.0 (modified)

Pott puffy

tumor • Pott puffy tumor with subdural empyema - Ganzer Fall bei Radiopaedia

Deng F, Pott puffy tumor with subdural empyema. Case study, Radiopaedia.org (Accessed on 12 Dec 2022) https://doi.org/10.53347/rID-88832 • CC by-nc-sa 3.0 (modified)

Radiopaedia • CC-by-nc-sa 3.0 • de

Pott puffy tumor refers to a non-neoplastic complication of acute sinusitis. It is characterized by a primarily subgaleal collection, subperiosteal abscess, and osteomyelitis. It is usually related to the frontal sinus but is sometimes secondary to mastoid pathology.

Rarer etiologies include trauma, intranasal cocaine, and methamphetamine abuse, and craniotomy.

Epidemiology

Although it may affect patients of any age, the incidence is higher in adolescence. It has become unusual since the availability of antibiotics.

Pathology

The infection erodes through the wall of the obstructed infected sinus to form a subperiosteal abscess. As expected it can be associated with extension intracranially with epidural abscess, subdural empyema, meningitis, and cerebral abscess formation. Dural sinus thrombosis is another possible complication.

Microbiology

The causative agent usually reflects the type of bacterial species responsible for community-acquired chronic sinusitis. The most common infective agents implicated are:

Streptococcus sp
Haemophilus influenzae
Staphylococcus sp
Klebsiella

Other reported organisms include

Pasteurella multocida

Radiographic features

CT

CT typically demonstrates an opacified frontal sinus with stranding and swelling of the overlying scalp. Bone algorithm will often demonstrate a defect in the anterior wall of the sinus.

Contrast may demonstrate a focal abscess, and may also allow intracranial complications to be better delineated.

MRI

Subtle intracranial involvement is more easily seen at MR imaging. With the injection of gadolinium-based contrast material, one may see early linear enhancement of the dura mater, an extra-axial fluid collection, or an area of cerebritis or focal cerebral abscess formation.

In the scalp, peripheral or rim contrast enhancement may be seen when an organized fluid collection is present.

Treatment and prognosis

Treatment is typically surgical with drainage of the abscess and at least 6 weeks of intravenous antibiotics.

History and etymology

It was first described by Sir Percivall Pott (see Pott disease) in 1760. The characteristic forehead swelling as a result of the subgaleal collection explains the "puffy tumor" part of the name.