Board Review 3 – Case 17

Neuroradiology board review. This lecture is geared towards the ABR core exam for residents, but it would be useful for review for the ABR certifying exam or certificate of added qualification (CAQ) exam for neuroradiology.

More description and the answer (spoiler!) are seen below the video.

https://youtu.be/nJLmYJalT8s

This case shows a CT with a soft tissue density mass extending from the frontal sinus through the outer table to the prefrontal scalp soft tissues.

The diagnosis is: frontal sinus osteomyelitis/Pott’s puffy tumor

Sometimes acute sinusitis can be complicated by adjacent osteomyelitis and bone destruction, such as in this case. The most likely location for this to happen is in the frontal sinus, when the diagnosis has the moniker “Pott’s puffy tumor”.

It is important when this happens to do an MRI of the brain to check for intracranial complications, such as meningitis, dural sinus invasion, and epidural abscess. The differential diagnosis includes malignancy (metastatic disease, lymphoma, and primary sinus malignancy), mucocele, and inflammatory diseases such as granolumatosis with polyangiitis.