A case of orbital cellulitis secondary to Pott puffy tumour in a teenage boy
Author: Maria Mas Castells
Base Hospital / Institution: Chelsea and Westminster Hospital
ePoster presentation
Abstract ID: 24-228
Purpose
To report a case of orbital cellulitis secondary to Pott puffy tumour in a teenage boy
Methods
An otherwise healthy 16-year-old male presented to the emergency department with sudden onset headache, fever and right frontal swelling. No history of trauma was documented. He described upper respiratory symptoms. CT orbits with contrast showed diffuse and extensive superficial right forehead swelling with no focal drainable collection. CT sinuses revealed opacified frontal, ethmoidal and paranasal sinuses.The patient was diagnosed with facial cellulitis secondary to bacterial sinusitis and received intravenous ceftriaxone and metronidazole.The right upper eyelid became progressively erythematous and oedematous causing a complete ptosis of the eyelid. A well-defined tender mass became palpable on the superior orbital rim. Given the rapid progression of the clinical picture into a suspected orbital cellulitis, repeat imaging was advised.
Results
MRI revealed a small frontal bone defect communicating with a subperiosteal abscess above the superior orbital rim. There was post-septal extension to the superior extraconal space without evidence of intracranial extension. The abscess and the sinuses were successfully drained and antibiotics were continued until a full clinical recovery was achieved.
Conclusion
Pott puffy tumour is a rare but severe non-neoplastic complication of frontal sinusitis characterised by osteomyelitis of the frontal bone with subperiosteal abscess presenting as frontal swelling in the paediatric and teenage population.The osteomyelitis can form a subperiosteal abscess as it erodes through the wall of the obstructed infected sinus. The infection may also extend intracranially to form an epidural abscess, cerebral abscess, subdural empyema, meningitis and dural sinus thrombosis. When the inferior wall of the frontal sinus is eroded the infection can extend to the orbits causing an orbital cellulitis. Early diagnostic and treatment with 6-8 weeks of intravenous antibiotics and surgical drainage are key to prevent complications and severe neurologic sequelae.
Additional Authors
| First name | Last name | Base Hospital / Institution |
|---|---|---|
| Anna | Palmer | Chelsea and Westminster Hospital |
| Richard | Scawn | Chelsea and Westminster Hospital |
| Manvi | Sobti | Chelsea and Westminster Hospital |
