What is hidden behind a forehead swelling: Pott's puffy tumor ?

Abstract

A 15-year-old boy was presented to the emergency room with a swelling on his forehead that was gradually progressing from past 10 days, which was accompanied by fever. The patient had no notable pathological history. In the ER, The patient was hemodynamically stable with a normal blood pressure level. During physical examination, a painful and renitent frontal swelling was noted without any skin modifications. The results of ophthalmologic, ear, nose, throat and cervical lymph node examinations were normal. No symptoms of upper respiratory infection or sinusitis were detected after the examination. A sample blood was collected and a blood infection was found with hyperleukocytosis and a high level of c-reactive protein was detected. A contrast-enhanced computed tomography displayed the accumulation of subgaleal fluid at the right frontal sinus (Fig. 1), where mucous was concentrated with bone lysis on sinus walls (Fig. 2).Figure 2Axial CT view showing the osteomyelitis of the frontal bone (asterisk).View Large Image Figure ViewerDownload Hi-res image Download (PPT) Frontal empyema was detected at the cerebrum level. Thus, Pott's puffy tumor was diagnosed and complicated by epidural frontal empyema. The patient underwent a surgical procedure, and antibiotic therapy was administered based on the results of the bacteriological analysis of the pus. Clinical and biological improvement was observed. The patient was discharged 20 days posthospitalization. The authors declare that they have no conflicts of interest.