Pott's puffy tumor, intracranial, and orbital complications as the initial presentation of sinusitis in healthy adolescents, a case series

Pott's puffy tumor (PPT) and intracranial complications of sinusitis are considered rare in the post-antibiotic era. We present a series of pediatric patients who were diagnosed with these complications. The purpose of this study is to discuss the clinical presentations and imaging findings in order to increase awareness of pediatricians and radiologists. A computer search identified nine pediatric patients who were admitted to our hospital between October 2006 and July 2009. The patients' charts and imaging studies were reviewed. There were eight males (11-16 years old) and one female (9 years old). All patients presented with significant headache and fever. Only two patients had sinusitis symptoms. CT and MRI revealed sinusitis in seven patients. These patients were diagnosed with epidural abscess (six), subdural empyema (one), PPT (five), focal meningitis (six), and orbital cellulitis (four). Two patients did not have sinusitis on the day of admission, but were treated recently for sinusitis. These two patients presented with frontal epidural abscess, PPT, thrombosis of the superior sagittal sinus, and frontal bone osteomyelitis. All patients were treated with a multidisciplinary approach and had good outcome with no residual neurologic deficits. Complications of sinusitis are not rare in the studied population. The presentation may be misleading. Therefore, a high index of suspicion is needed, particularly in adolescent males who present with significant headache and fever. Evaluation with contrast-enhanced CT of the brain, sinuses, and orbits should be done first, followed by MRI examinations.