Pott’s Puffy Tumor: A Rare Complication of Mastoiditis

Abstract

Pott’s puffy tumor is rarely seen in the modern era of antibiotics. It is usually seen as intracranial complication following inappropriately treated frontal sinusitis. Up until 2001 there have been only 21 pediatric cases reported in the literature and most have been secondary to frontal sinusitis. Only 1 case has been reported following a latent mastoiditis and that has been in an adult [<citeref rid="ref001">1</citeref>]. We report a case in a child who developed Pott’s puffy tumor following mastoiditis.

Pott’s Puffy Tumor: An Uncommon Clinical Entity

“…It is most commonly due to frontal sinusitis and may spread due to frontal sinus trauma, hematogenous spread of sinusitis, or retrograde thrombophlebitis via the diploic veins of Galen [5]. Pott's puffy tumor secondary to mastoiditis, insect bites, malignancy, and acupuncture has also been described [2, 6, 7]. …”

“…Presentation can include headache, vomiting, fever, seizures, periorbital or scalp swelling, nasal or aural discharge, or focal deficits [2]. Signs and symptoms can range from a relatively indolent course consisting of headache, rhinorrhea, and fever to focal neurologic findings and altered consciousness [8].…”

“…Sir Percival Pott first described the phenomenon of a Pott's puffy tumor as frontal swelling with a subperiosteal abscess and extradural empyema in 1775 [1, 2]. Although rare since the advent of modern antibiotic therapy, one must have a high index of suspicion for this process given the risks of intracranial sequelae if left unaddressed.…”

Pott's puffy tumor: A rare complication of acute otitis media in child: A case report

“…The common symptoms are ear pain, headaches, fever, signs of respiratory tract infection, vomiting, itching, tension in the skin of the scalp and others [17]. Ear discharge may or may not be present; completely intact or only mildly hyperemic eardrum have been reported in the literature, or intracranial complications may be the only signs of mastoiditis [11]. Our patient had fever, signs of respiratory infections, and symptoms of acute unilateral otitis, but no signs of acute mastoiditis were initially present.…”

“…As of 2014, only 36 pediatric cases have been reported in the literature, mostly as a complication of sinusitis (according to MEDLINE). To date, only one case of PPT has been described in the literature as a complication of latent mastoiditis in an adult [10], and one case of PPT as a complication of acute mastoiditis in a 10-year-old child [11].…”