A 77-year-old female with a history of chronic sinusitis presented with left periorbital pain for five days. The patient showed preseptal and left nasal swelling upon examination (Image A). She was given oral antibiotics to combat the cellulitis.

Despite compliance with these antibiotics, the patient’s condition did not improve. Instead, she saw a dramatic increase in swelling five days after she started oral antibiotics (Image B).

Julian Perry, MD, staff ophthalmologist at Cole Eye Institute, explained, “This patient presented with this uncommon entity in our outpatient service. Externally, it looked like acute dacryocystitis. However, the slightly anterior nature of the abscess increased our suspicion for a process arising from the frontal sinus.”

A CT scan was ordered.

CT imaging revealed a destructive infection within the frontal sinus, causing some erosion of the anterior table. The abscess extended along the inferior portion of the frontal sinus (Image C). Pott’s puffy tumor typically manifests with swelling on the forehead associated with the frontal sinusitis and subperiosteal abscess. However, the patient’s symptoms and the CT imaging confirmed Dr. Perry’s theory that she had a rare presentation of Pott’s puffy tumor.

The patient’s symptoms were resolved with the combination of endoscopic treatment and extended intravenous antibiotics.

These images originally appeared in: Ganapathy P, Chundry R, Perry JD. Pott’s puffy tumor: a rare presentation. Ophthal Plast Reconstr Surg. 2016 Aug 16. [Epub ahead of print]. Reproduced with permission from Wolters Kluwer.