A 60 y.o. male presents with swelling over the L eye

What could be wrong?

What is wrong on the CT?

Our patient had a Pott’s puffy tumor. Percival Potts first described the condition in relation to an infection occurring after a frontal skull fracture in 1765. It describes an osteomyelitis of the frontal bone with a subperiosteal abscess causing a swelling over the frontal bone and orbit. The most frequent causes are sinusitis,dental infection, trauma or surgery.

Patients most often present with headache, fever, or signs of meningitis. The veins of the frontal sinus drain through diploic veins into the dural venous plexus and can cause meningitis with or without an erosion of the bone itself. In addition to meninigitis, subdural abscess and dural sinus thrombosis may occur.

Pott’s puffy tumor on CT.

The treatment of Pott’s puffy tumor is a combination of surgery and antibiotics. The coverage is gram posiitve and anaerobic. Our patient was treated with antibiotics and surgery. he had an ethmoidectomy, sphenoidotomy , frontal sinusotomy and removal of the teeth causing the maxillary sinusitis. He recovered.

Tudor R, Carson J, Pulliam M, Hill A. Potts puffy tumor frontal sinusitis , frontal bone osteomyelitis and epidural abscess secondary to a wrestling injury. Am J Sports Med 1981;9(6):390-91.

Nisa L, Landis B, Gigen R. Orbital involvement in Potts puffy tumor: a systematic review of published cases. Am J Rhinol Allergy 2012; 26(2) e 63-70.

Pranav Sharma, MD, Salil Sharma, MD, Nishant Gupta, Pott puffy tumor. Proc(Baylor Univ Med Cent) 2017. Apr; 30(2): 179–181.