Pott puffy tumour

Case contribution: Dr Radhiana Hassan


  • A 46 years old male with chronic sinusitis
  • Presented with right frontal swelling and headache
  • Blood investigation: Hb=13.4, TWBC= 7.7

CT scan findings:

  • There is expansion with total opacification of both frontal sinuses.
  • The sinuses are filled with soft tissue density lesion.
  • There is associated intralesional calcification and hyperdense areas within the left frontal sinus.
  • This lesion is seen extending anteriorly into the subgaleal region (yellow arrows).
  • No calcification or air pockets within.
  • There is also soft tissue swelling at right preseptal region.
  • The walls of the right frontal sinus, right ethmoidal air cells and medial wall of the right orbit are sclerosed.
  • Bony defect at anterior wall of right frontal sinus is also noted (red arrows).
  • Subtle lytic destruction is also seen involving posterior wall of right frontal sinus and right lamina papyracea.
  • Both cribriform plates and nasal septum are intact.
  • No obvious intra orbital or intracranial extension is seen.

Diagnosis: Pott puffy tumour

Progress of patient:

  • FESS and open frontal sinus surgery performed.


  • It refers to clinical presentation of a frontal mass as a result of osteomyelitis with subperiosteal abscess, most commonly as a complication of frontal sinusitis.
  • It is a non-neoplastic condition predominantly affects children and adolescents.
  • Children are more susceptible because of anatomic and physiologic changes in the developing frontal sinus.
  • It is characterized by subgaleal collection, periosteal abscess and osteomyelitis.
  • It is usually related to frontal sinus but sometimes can be secondary to mastoid pathology.
  • It has become unusual since the availability of antibiotics.
  • The most common organisms are Streptococcus spp., Haemophilus influenza, Staphylococcus spp and Klebsiella sp.
  • CT typically demonstrate an opacified frontal sinus with stranding and swelling of the overlying scalp.
  • Bone window shows defect of anterior wall of the sinus. Contrast study shows focal abscess and may also show intracranial complication.
  • MRI is better to delineate subtle findings such as enhancement of dura mater, extra axial fluid collection and area of cerebritis or cerebral abscess.
  • Transcortical spreading can result in severe intracranial and orbital complications. Early detection and treatment are crucial because of these potentially life-threatening complications.
Author: radhianahassan