Pott's puffy tumour

A contrast computed tomography (CT) scan of the head and sinuses (Fig. 2) and subsequent magnetic resonance imaging (MRI) of the brain were performed. Extensive sinusitis of the left maxillary and bifrontal sinuses, complicated by extensive, shallow bifrontal subdural collections with cerebritis and superior sagittal sinus thrombosis were detected. A diagnosis of Pott’s puffy tumour (frontal skull bone osteomyelitis) was made. Drainage of the frontal and maxillary sinuses yielded 20 mL of purulent fluid. Empirical antibiotic treatment commenced with intravenous vancomycin, ceftriaxone and metronidazole. Streptococcus intermedius (also known as Streptococcus milleri) and Fusobacterium nucleatum were cultured from sinus fluid. The subdural collections were not drained and he continued on a 6-week course of intravenous ceftriaxone and metronidazole. Pott’s puffy tumour is a rare and frequently forgotten complication of bacterial sinusitis, characterised by frontal bone osteomyelitis and subperiosteal abscess. It classically presents as fever and headache, accompanied by oedema and erythema of the forehead or periorbital region. In children who develop a Pott’s puffy tumour, secondary intracranial extension is common, occurring in more than half of the paediatric cases. Because this condition is rare and no longer well known amongst clinicians, diagnosis may be delayed. Pott’s puffy tumour is more frequently diagnosed in older children (mean age of 11 years), as the frontal sinus is the last sinus in children to pneumatise. This case is one of the youngest reported in the medical literature and illustrates the importance of considering the diagnosis even in preschool aged children. The diagnosis is confirmed with CT and MRI to determine the extent of intracranial involvement. It is treated with radical surgical drainage of the sinuses and broadspectrum intravenous antibiotics. Neurosurgical opinion should be sought in the presence of intracranial collection.