Pott’s puffy tumour and subdural abscess as a complication of acute rhinosinusitis – a case report

Overview

Rhinogenic inflammatory intracranial complications are relatively rare, but they are very serious and can be fatal. The diagnosis is mainly based on anamnesis, objective examination, imaging methods and laboratory findings. Our case study is devoted to an intracranial complication of sinusitis of a 17-year-old patient. It was a subperiosteal abscess with simultaneous subdural abscess in the frontal region and osteomyelitis of the frontal bone. The patient came to the otorhinolaryngology clinic at Jičín Regional Hospital with prolonged rhinosinusitis, after already receiving primary therapy of oral aminopenicillin with a temporary effect. An objective examination revealed slight swelling in the area of the root of the nose and eyelids, rhinoendoscopic swelling of the mucous membranes with mucopurulent secretion in the middle nasal passage on the left. The original suspicion of an orbital complication of rhinosinusitis was ruled out by a CT scan. The patient was hospitalized and treated with intravenous antibiotics, corticoids and the nasal cavity was treated locally and the inflammatory parameters decreased gradually. During hospitalization, swelling of soft tissues progressed frontally, without neurological symptoms. Due to the suspicion that there was an intracranial complication of rhinosinusitis, a CT scan of the paranasal sinuses and brain was performed. The radiologist diagnosed subdural empyema and osteomyelitis of the frontal bones. An acute transfer to the neurosurgery clinic of the University Hospital in Hradec Králové for intravenous antibiotic therapy and surgical intervention by a neurosurgeon and otorhinolaryngologist was arranged. Postoperative healing was favourable.

Keywords:

Osteomyelitis – paranasal sinuses – sinusitis – subdural abscess