Pott’s puffy tumor not uncommon in teens with prolonged headache, frontal swelling

A recent study recommends having a high index of suspicion for Pott’s puffy tumour (PPT), a rare complication of frontal sinusitis, among adolescents who present with prolonged headache or frontal swelling.

Contrast-enhanced computed tomography (CT) may be used for the initial evaluation, but a magnetic resonance imaging (MRI) must be performed to determine whether intracranial interventional treatments are necessary should any suspicion of intracranial involvement arises, according to the investigators.

A series of 10 paediatric patients aged 9‒17 years presenting with PPT in two tertiary care paediatric hospitals in central Israel between January 2018 and August 2022 was reported. The investigators then reviewed the published literature regarding paediatric PPT.

Headache (10 cases) was the most common clinical presentation among patients, followed by frontal swelling (six cases) and fever (five cases). Symptom duration prior to admission ranged from 1 to 28 days (median 10 days).

Clinicians diagnosed PPT via imaging studies at a median of 1 day following admission. All 10 patients underwent CT studies, while six children also had MRI. Intracranial complications occurred in 70 percent of patients. All children received systemic antibiotics and underwent surgical interventions.

The most common causal bacteria belonged to the Streptococcus constellatus group. All patients recovered without any serious events.

“Complete recovery can be expected with appropriate antibiotic treatment and surgical intervention in most of the cases,” the investigator said.