Clinical communication: AdultPott's Puffy Tumor and Epidural Abscess Arising from Pansinusitis
Introduction
Sinusitis is a common condition, but serious complications of sinusitis have become quite rare since the advent of antibiotics. It is estimated that 13% of the population of the United States suffers from chronic rhinosinusitis annually, making it one of the most common chronic diseases (1). Although uncommon, recurrent or chronic sinusitis can lead to periorbital or orbital cellulitis, intracranial abscess or meningitis, subperiosteal scalp abscess (“Pott's puffy tumor”), osteomyelitis, and cavernous sinus thrombosis. These serious complications of sinusitis are often subtle in their presentation but require prompt medical and surgical therapy to minimize potentially catastrophic sequelae. Particular attention should be paid to immunocompromised patients and intravenous (i.v.) drug abusers in the investigation of complications.
This case report describes a patient with chronic pansinusitis who presented to the Emergency Department (ED) with Pott's puffy tumor and an intracranial abscess requiring otolaryngological and neurosurgical interventions. This case demonstrates the importance of assuring adequate follow-up or immediate hospital admission, because the patient sought emergency medical attention before the abscess formed but did not pursue the recommended treatment with Otolaryngology after discharge from the ED. Although the patient appeared well clinically, the spread of the infection and the associated morbidity potentially could have been avoided with more aggressive initial management.
Section snippets
Case Report
A 41-year-old man presented with a 4-day history of headache, nasal discharge, and swelling of the left side of the forehead. The patient was alert and oriented. An oral temperature was 37.7°C (100°F), heart rate 92 beats/min, respiratory rate 20 breaths/min, blood pressure 125/81 mm Hg, and oxygen saturation (SaO2) 97% on room air. On physical examination, focal soft tissue swelling was noted without erythema or tenderness in the left frontal scalp region. The tympanic membranes were clear and
Discussion
Any discussion of Pott's puffy tumor must start with a review of sinusitis and clarification of the correct descriptive terminology. There is a continuum of the sinus disease processes and it is often difficult clinically to know exactly where on the continuum the patient lies. Rhinosinusitis refers to inflammation of the nasal and paranasal (ethmoidal and maxillary) sinus mucosa (2). Monosinusitis usually refers to limited inflammation of the maxillary sinuses but may actually be of any
Conclusions
Despite the rarity of cases of Pott's puffy tumor, it is a complicated infection that requires aggressive therapy and typically warrants hospital admission. Patients suffering from Pott's puffy tumor generally do not appear acutely ill and the physical examination findings may be subtle. This may lead the clinician to underestimate the urgency of this disorder. Proper diagnosis via contrast-enhanced CT scan is critical to assure prompt i.v. antibiotic administration and appropriate
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Cited by (25)
Intracranial empyema complicating sinusitis in childhood: Epidemiology, imaging findings and outcome
2022, International Journal of Pediatric OtorhinolaryngologyCitation Excerpt :According to us, the delay in diagnosis of sinusitis was probably due to a lack of sinusitis symptoms, such as nasal congestion and rhinorrhea. The rarity of life-threatening complications in the post-antibiotic period and the absence of neurological signs may delay significatively the diagnosis [3–12]. Headache is a subjective symptom; intensity may be underestimated.
Pott's puffy tumor: rare complication of sinusitis
2020, Brazilian Journal of OtorhinolaryngologyPott's puffy tumor caused by Actinomyces naeslundii
2020, IDCasesLethal complication in Pott's Puffy tumor: A case report
2018, Journal of Forensic Radiology and ImagingCitation Excerpt :Since the advent and widespread prescription of antibiotic therapy, Pott's puffy tumor has become a rare entity [4,10]. Intracranial complications with or without direct erosion of the fontal bone have been observed in about 60% to 85% of these patients [11–15]. The pus may erode the bony walls of the sinuses, directly invading the leptomeninges, or bacteria may infect the bridging veins that run through the bony calvarium and leptomeninges, carrying bacteria along the veins into the leptomeninges [16].
Subcutaneous emphysema after vigorous sneezing in the setting of acute frontal sinusitis
2017, American Journal of Otolaryngology - Head and Neck Medicine and SurgeryCitation Excerpt :In this patient with acute frontal sinusitis, we posit that an episode of vigorous sneezing led to a rapid increase in intranasal pressure and subsequent perforation and expulsion of air through the anterior table of the frontal sinus, which was likely destabilized by the infection. Extension of infection across the anterior table of the frontal sinus has been well-described in the literature, and can result in soft tissue inflammation and subperiosteal abscess, known as Pott's puffy tumor [34–37]. Our case is differentiated from the typical presentation of soft tissue infection associated with frontal sinusitis by the rapid onset of facial swelling and crepitus caused by sneezing.
Fever and neurologic conditions
2013, Emergency Medicine Clinics of North AmericaCitation Excerpt :The lesions are typically found in territories supplied by the middle cerebral artery. Infectious spread from nearby structures can arise from complications of sinusitis, dental infection, or otitis media.75–85 Direct implantation can be caused by indwelling neurosurgical hardware, such as a halo device, or penetrating trauma.86