Thursday, March 7, 2013

Puffy

Only 20-25 cases of this disease have been described in the literature in the post-antibiotic era. A 10 year old girl is involved in a car accident where she has some mild facial trauma. Her head CT at the time is only notable for some sinusitis; she is observed for 24 hours and then discharged home. She then presents again to the emergency department with forehead swelling, headache, fever, chills, and rhinorrhea. Exam shows a minimally tender area of doughy, puffy edema. Her cranial nerve exam is normal. She has an elevated WBC count, ESR, CRP, and the CT shown above.

Challenge: What's the diagnosis?

Image shown with permission from radswiki.net.

2 comments:

Alex said...

she's got an intracranial abscess above the cribiform plate. is this a T1 post-gad? if so, she might have pachymeningeal enhancement.

Craig Chen said...

yes - this is an abscess, nice call
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Puffy

Described by Sir Percivall Pott in 1768, this is none other than Potts puffy tumor, a rare clinical entity characterized by subperiosteal abscess associated with osteomyelitis.

Source: Journal of Craniofacial Surgery; Wikipedia.