Pott puffy tumour

Background

• Subperiosteal abscess of the forehead involving frontal bone osteomyelitis
• Often a complication of untreated bacterial sinusitis, so quite rare since the advent of antibiotics
• Named after Percival Pott, also known for Pott syndrome and Pott fracture

Microbiology

• Half are polymicrobial, including streptococci, oral anaerobes, and staphylococci
• Reports of Fusobacterium necrophorum, Haemophilus influenzae, and GI pathogens

Clinical Manifestations

• Fluctuant, tender swelling of the forehead, often described as "doughy"
• Complications are common, with epidural and subdural abscesses being the most common
  • Other intracranial complications: frontal lobe abscess, meningitis/encephalitis, dural venous sinus thrombosis, cavernous sinus thrombosis, and cortical venous thrombosis
  • Orbital complications: orbital cellulitis, orbital abscess

Investigations

• CT sinuses, or MRI

Management

• Empiric broad-spectrum antibiotics, possibly including CNS coverage
• Duration as per osteomyelitis, between 4 to 8 weeks
• May need surgical debridement