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Vol. 16. Issue 1.
Pages 54-57 (January 2005)
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Vol. 16. Issue 1.
Pages 54-57 (January 2005)
Pott's puffy tumor of the vertex years after trauma in a diabetic patient: case report
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Ç. Evliyaoglu
, G. Bademci, E. Yucel, S. Keskil
Department of Neurosurgery. Kirikkale University School of Medicine. Kirikkale. Turkey
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Summary

Pott's puffy tumor is a rare clinical entity characterized by subperiosteal abscess associated with osteomyelitis. It is usually seen as a complication of frontal sinusitis or trauma. This is the unique report of a Pott's puffy tumor located over the vertex of a type 1 diabetic patient with an unusual latency of 14 years following injury.

A 27-year old man presented with pain and a soft swelling on his vertex. Magnetic resonance imaging demonstrated subperiosteal abscess in the vertex region associated with dural thickening and perisinusal irregularities of epidural space. Further history revealed that he had a trauma to the same location when he was 13 years old.

Considering possible complications due to proximity of the lesion to the sagittal sinus, we retrained from aggressive surgical interventions. We treated our patient with a simple surgical abscess drainage followed by prolonged use of antibiotics and achieved complete therapy.

The cellular and humoral elements of the immune system may be disrupted in diabetic patients resulting in such atypical courses and complications of infections. We want to emphasize both importance of the prompt diagnosis of Pott's puffy tumor as intracranial invasion may cause severe neurologic problems, and importance of a surgical intervention tailored for the individual lesion.

Key words:
Pott's puffy tumor
Osteomyelitis
Scalp abscess
Trauma
Diabetes
Resumen

El tumor “hinchado” de Pott es una entidad rara, caracterizada por un absceso subperióstico asociado a una osteomielitis. Se ve habitualmente como una complicación de sinusitis frontal o de un traumatismo. Esta es la única comunicación de un tumor hinchado de Pott localizado en el vértex craneal de un paciente diabético con una latencia, poco habitual, de 14 años.

Se presenta el caso de un varón de 27 años con dolor e hinchazón en el vértex. La resonancia magnética demostró un absceso subperióstico en la región del vértex, asociado a un engrosamiento de la duramadre e irregularidades en torno al seno longitudinal superior, en el espacio epidural. En la historia posterior se recogió que había sufrido un traumatismo en la misma localización cuando tenía 13 años.

Al considerar las posibles complicaciones, debido a la proximidad de la lesión al seno sagital, nos abstuvimos de un tratamiento quirúrgico muy agresivo. Tratamos al paciente con un drenaje simple del absceso, seguido de un tratamiento prolongado con antibióticos y se consiguió la curación completa.

Los elementos celulares y humorales del sistema inmunológico pueden estar alterados en los pacientes diabéticos, lo cual da lugar a evoluciones atípicas y a complicaciones infecciosas. Queremos poner de relieve la importancia de un diagnóstico precoz de un absceso de Pott, puesto que la invasión intracraneal puede dar lugar a graves problemas neurológicos, y la importancia de una intervención quirúrgica adecuada a cada tipo de lesión.

Palabras clave:
Tumor hinchado de Pott
Osteomielitis
Absceso del cuero cabelludo
Trauma
Diabetes

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