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. 2022 May:94:106975.
doi: 10.1016/j.ijscr.2022.106975. Epub 2022 Mar 29.

Misdiagnosed epidermoid cyst appears Potts Puffy Tumor: A case report and literature review

R Salemans  1 , E Bijkerk  1 , J Sawor  2 , A Piatkowski  3
Affiliations

Misdiagnosed epidermoid cyst appears Potts Puffy Tumor: A case report and literature review

R Salemans et al. Int J Surg Case Rep. 2022 May.

Abstract

Introduction: Although nowadays rare, Potts Puffy Tumor (PPT) is a rare but serious diagnosis characterized by osteomyelitis of the frontal bone. The introduction of broad-spectrum antibiotics made PPT an uncommon diagnosis in modern medicine, and it is mostly seen as a complication of frontal sinusitis in children and adolescents.

Case presentation: We report a case of PPT in an elderly man with a sudden and increasing swelling of the forehead, which was initially diagnosed as an epidermoid cyst. Subsequent surgical exploration revealed osteomyelitis of the underlying frontal bone. Medical imaging by computed tomography (CT) and magnetic resonance imaging (MRI) was done, and treatment with Functional Endoscopic Sinus Surgery (FESS) and reconstructive surgery of the frontal bone was conducted.

Discussion: PPT is a rare, yet serious condition which is usually seen as a complication of chronic sinusitis which causes osteomyelitis and a subperiosteal abscess. Despite the atypical presentation of symptoms, the reported case underlines the importance of rapid deployment of medical imaging, referral, and administration of broad-spectrum antibiotics. Furthermore, surgical intervention is indicated in most cases. When left untreated, PPT can result in severe intracranial complications.

Conclusion: The diagnosis PTT is still relevant and may have a nonspecific presentation. A persisting epidermoid cyst after drainage should lead to the suspicion of a PTT. Immediate imaging and adequate treatment are required to prevent serious, potentially lethal intracranial complications.

Keywords: Case report; Epidermoid cyst; Potts Puffy Tumor.

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Conflict of interest statement

There were no conflicts of interest.

Figures

Fig. 1
Fig. 1
Frontal skin lesion paramedian left at the time of presentation.
Fig. 2
Fig. 2
Perioperative exploration of the defect with forceps, approximately 3 cm deep.
Fig. 3
Fig. 3
A) Axial view of the CT of the sinuses indicates a ventral defect with a diameter of approximately 2 × 1.5 cm. B) Sagittal view of the CT showing an osseous defect of approximately 5 mm in de dorsal wall of the left frontal sinus.
Fig. 4
Fig. 4
Frontal scar nine days after FESS.
See this image and copyright information in PMC

References

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