Dear Editor,
A girl aged 9 years came to our observation because of fever, headache and swelling of the forehead. She was diagnosed as having frontal sinusitis about 15 days before and treated with amoxicillin-clavulanate at the dose of 50 mg/kg in two daily doses for 7 days with partial resolution of symptoms. Five days before our visit, a cutaneous lesion of 0.5 cm in diameter appeared on the forehead, which gradually increased in volume. After our evaluation, the patient underwent a computerized tomography scan of the paranasal sinuses, which showed inflammatory secretions in the frontal, maxillary, and anterior ethmoid sinuses. Erosions of both anterior and posterior tables of the right frontal sinus were evident with communication of the secretive material both externally with the soft tissues, and internally with the superior sagittal sinus (Figure 1). Diagnosis of Pott’s “puffy” tumor was made. Pediatricians must be aware of this rare complication of sinusitis in older children and adolescents. The presence of a “puffy” forehead lesion with a history of previous sinusitis are red flags to suspect Pott’s “puffy” tumor. It is characterized by osteomyelitis of the frontal bone, which eventually leads to intracranial complications (1).
Figure 1. a, b.
Transverse CT image. The thin arrow indicates the erosion of the anterior table or the right frontal sinus. The thick arrow indicates the erosion of the posterior table of the right frontal sinus (a). Sagittal CT image. The thick arrow indicates the communication between the secretive materials of the right frontal sinus with the superior sagittal sinus. The thin arrow indicates the external erosion of the anterior table of the right frontal sinus (b)
References
- 1.Jafri L, Farooq O. Pott’s puffy tumor. Pediatr Neurol. 2015;52:250–1. doi: 10.1016/j.pediatrneurol.2014.08.024. https://doi.org/10.1016/j.pediatrneurol.2014.08.024. [DOI] [PubMed] [Google Scholar]