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"The weird head lump!!"

Updated: Feb 13

69 years old male, presented to ED feeling unwell, confused, with an acute onset of forehead swelling of 1-week duration, that got worse in the last 24 h.


There was also a history of recurrent sinusitis.


Observations in ED:

P: 125,      BP: 95/55,      RR: 28,     Sat: 94% OA.      GCS 13/15


Here is a photo of the forehead lump with permission from the patient.


What is the most likely diagnosis?


Diagnosis:

Looking at the presentation & the location & shape of the swelling, the most likely diagnosis here is "Pott’s Puffy Tumour"

Overview:

  • It is a rare, non-neoplastic complication of frontal sinusitis or trauma.

  • It is osteomyelitis of the frontal bone with associated subperiosteal abscess.

  • It was first described by Sir Percival Pott in 1768.

  • Often polymicrobial, with streptococci, staphylococci, and anaerobic bacteria, Hence, antibiotic coverage should include gram-positive and anaerobes.


Clinical presentation:

  • Symptoms include headache, periorbital swelling, fever, purulent rhinorrhoea, & vomiting.

  • Signs of meningitis or encephalitis.

  • Intracranial complications occur either due to direct extension or venous drainage.


Complications:

  • include meningitis, epidural, subdural abscess, & venous sinus thrombosis.

  • If the inferior wall of the frontal sinus is involved, infection may spread to the orbits, causing either orbital cellulitis or intra-orbital abscess.


Investigations:

  • CT/MRI are required for diagnosis (Misdiagnosing as a simple infected skin cyst can be fatal).




"Here is the CT of the head of this patient, shared with his permission"



Treatment:

  • Surgical drainage, is the standard of care.

  • Broad-spectrum antibiotics for 4 to 6 weeks.


Here is a link to a video that discusses the above case with some more details:



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Noté 5 étoiles sur 5.

Thanks a lot for your efforts

Totally agree: we can't see what we don't know

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Thee
Thee
19 janv.
Noté 5 étoiles sur 5.

Thanks Boss for another interesting and informative one. 🙏

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