Puffy Tumor: “I’m Not a Klingon, It’s an Abscess!”

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© Springer Nature Switzerland AG 2020
C. G. Kaide, C. E. San Miguel (eds.)Case Studies in Emergency Medicinehttps://doi.org/10.1007/978-3-030-22445-5_52



52. Pott’s Puffy Tumor: “I’m Not a Klingon, It’s an Abscess!”



Christopher Lee1   and David Bahner1  


(1)
Department of Emergency Medicine, Wexner Medical Center at The Ohio State University, Columbus, OH, USA

 



 

Christopher Lee (Corresponding author)

Email: christopher.lee@osumc.edu


 

David Bahner

Email: david.bahner@osumc.edu


Keywords

PottsOsteomyelitisSinusitisPediatrics


Case


Pertinent History


An 18-year-old male presented with his roommate with 1 week of progressive forehead swelling and sleepiness. Patient had an upper respiratory infection starting 3 weeks ago with rhinorrhea, sore throat, and headache that progressed to sinus pain and fever. He saw his primary physician and was prescribed a 10-day course of amoxicillin. He had improvement of his symptoms but he did not feel completely back to baseline. For the past week, his headache has gotten worse and he noticed a tender bump on his forehead that had progressively gotten larger in addition to having low-grade fevers. This morning his roommate noticed that he was sleepier than usual and had an episode of vomiting, prompting him to bring the patient to the Emergency Department (ED). The roommate denied any knowledge of trauma and said that the patient was acting normally yesterday evening.


Pertinent Physical Exam


Except as noted below, the findings of the complete physical exam are within normal limits.



  • Vitals: Temperature 101.8, Heart Rate 100, Respiratory Rate 14, Blood Pressure 100/50, Saturation 99% on room air



  • Head, Ears, Eyes, Nose, and Throat (HEENT): Atraumatic, normocephalic, 3-cm diameter area of induration on the right forehead, tender to palpation, no overlying redness, drainage, nasal turbinates erythematous without drainage, bilateral tympanic membranes with intact light reflex.



  • Eyes: Pupils Equal, Round, Reactive to Light and Accommodation (PERRLA); Extraocular Movements Intact (EOMI); no injection



  • Cardiovascular (CV): Tachycardic, regular rhythm, no murmurs/rub/gallop, normal S1 and S2



  • Neuro: Somnolent, GCS 14 (E3, V5, M6), CNII-XII intact, Strength 5/5 bilaterally in upper and lower extremities bilaterally, intact sensation, no dysmetria.


Past Medical History/Social History/Family History


Noncontributory





































































Pertinent lab work


Test

Results


0700

Results


1200

Results


1500

Units

Normal range

WBC

12.3

15.5

17.9

K/uL

3.8–11.0 · 103/mm3


Hgb

13.3

12.9

13.0

g/dL

(Male) 14–18 g/dL


(Female) 11–16 g/dL


Lactate

2.1

2.7

3.1

mmol/L

<2.0


pH

7.32

7.29

7.23

–

7.35–7.45


ESR

70

86

90

mm/h

(Male) 0–22 mm/h


(Female) 0–29 mm/h


CRP

132

139

145

mg/L

<3 mg/L


Creatinine

0.75

0.79

0.77

mg/dL

0.6–1.5 mg/dL



WBC white blood cell, Hgb Hemoglobin, ESR Erythrocyte sedimentation rate, CRP C-reactive protein



CT Head


2 cm × 2 cm periosteal abscess in the right frontal bone anteriorly. Bilateral frontal sinuses completely opacified. Adjacent to this abscess, there is a complex subdural fluid collection with 2 mm of right-to-left midline shift.

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Mar 15, 2021 | Posted by in EMERGENCY MEDICINE | Comments Off on Puffy Tumor: “I’m Not a Klingon, It’s an Abscess!”

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