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INFECTIOUS DISEASES

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Pott's Puffy Tumor ... Pott's Puffy Tumor. Children have more diploic veins in the cranium than adults do. ... Pott's puffy tumor. Superior sagittal sinus thrombosis ... – PowerPoint PPT presentation

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Title: INFECTIOUS DISEASES


1
INFECTIOUS DISEASES CASE CONFERENCE
  • Pimpawan Boapimp, MD
  • Wake Forest Baptist Medical Center
  • October 18, 2004

2
HPI
  • 37 year old WM
  • One month PTA, he had Lt-sided facial swelling,
    pain, and a knot on his Lt forehead
  • Was diagnosed with acute sinusitis and was
    treated with antibiotics for 7 days.
  • Symptoms resolved except a knot was still there
  • One week PTA, he started having same symptoms
    with an intense left periorbital pain.

3
HPI
  • No F/C, night sweats
  • Photophobia without visual changes
  • No N/V
  • Was seen in ED at OSH and had CT scan head done.
  • Was referred to WFUBMC.

4
Physical examination
  • T 98.8 P 80 RR 18 BP 122/71 PO 96 RA
  • GA AO X 3, afebrile, NAD
  • HEENT 5 X 5 cms area of swelling at Lt forehead,
    tender at mass and Lt side of the face
  • Chest CTA bilaterally
  • Heart RSR, normal S1, S2, no murmur
  • Abd Benign
  • Ext No edema
  • NS No focal deficit

5
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8
  • Abscess from forehead
  • PEPTOSTREPTOCOCCUS SPECIES
  • SULBACTAM/AMP lt1 SUSCEPTIBLE
  • CEFOXITIN lt2 SUSCEPTIBLE
  • CEFOTETAN 4 SUSCEPTIBLE
  • CEFTIZOXIME 4 SUSCEPTIBLE
  • CEFOTAXIME lt2 SUSCEPTIBLE
  • CEFTRIAXONE lt2 SUSCEPTIBLE
  • CHLORAMPHENICOL 4 SUSCEPTIBLE
  • PENICILLIN G lt0.06 SUSCEPTIBLE
  • CLINDAMYCIN lt0.5 SUSCEPTIBLE
  • METRONIDAZOLE gt16 RESISTANT
  • TETRACYCLINE lt0.5 SUSCEPTIBLE
  • IMIPENEM lt0.5 SUSCEPTIBLE
  • PIPERACILLIN lt4 SUSCEPTIBLE
  • TICAR/CLAVULANIC lt4 SUSCEPTIBLE
  • MEZLOCILLIN lt4 SUSCEPTIBLE

9
DIAGNOSIS ?
10
  • Ceftriaxone x 6 weeks
  • F/U in IDSC

11
Follow Up
  • After 2 weeks of ceftriaxone, F/U with ENT

12
2 week F/U Facial CT scan
Sub-galeal fluid collection
13
2 week F/U Facial CT scan
Osteomyelitis
14
2 week F/U Facial CT scan
15
2 week F/U Facial CT scan
16
Follow Up
  • ENT did I and D of forehead abscess with penrose
    drain.
  • Drain was removed one week after that.

17
Follow Up
  • After 4 weeks of ceftriaxone, F/U with ID.
  • Clinically improved.

18
6 week F/U Facial CT scan
19
Potts Puffy Tumor
  • Named after Sir Pervical Pott.
  • An English surgeon who described it in 1760.
  • Subperiosteal abscess and osteomyelitis of the
    frontal bone.

20
Potts Puffy Tumor
  • Sinus infection can easily spread to the orbit or
    to the orbital or intracranial cavity because of
    the anatomy.
  • All sinuses share thin bony walls with the orbit
    and the cranium.
  • Sinus veins also communicate with ophthalmic
    venous system

21
Potts Puffy Tumor
  • The ophthalmic venous system has no valves
    allow for an easy spread of infection.
  • Lack of lymphatic system in the orbit also
    facilitates the spread of the infection.
  • The cranial dura and galea derive blood supply
    from the same system.

22
Potts Puffy Tumor
  • Children have more diploic veins in the cranium
    than adults do.
  • Allows infection to spread more deeply and more
    rapidly.

23
  • Meningitis is the most common complication of
    sinusitis.
  • Frequently the result of sphenoiditis or
    ethmoiditis.
  • HA, neck stiffness, fever
  • CN palsy is frequently present.
  • The most common abn. is a dysfunction of
    extraocular movement.
  • Need CT brain before LP

24
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25
Trephination
26
Intracranial complications of sinusitis
  • Retrospective chart review of 82 adults and
    children
  • From Jan 1, 1985 to Dec 31, 1999
  • 39 pts (47.6) had intracranial complications
  • 43 pts (52.4) had orbital complications

Ear Nose Throat J. 2002 Sep81(9)636-8, 640-2,
644. Intracranial complications of sinusitis a
15-year review of 39 cases. Younis RT, Lazar RH,
Anand VK.
27
  • 39 pts with intracranial complications
  • 23 adults and 16 children
  • most common complications
  • - meningitis 21 pts (53.8)
  • - epidural abscess 6 pts (15.4)
  • - subdural abscess 5 pts (12.8)
  • - intracerebral abscess 4 pts (10.3)
  • - epidural abscess and Potts puffy tumor 1 pt
    (2.6)
  • - Potts puffy tumor alone 1 pt

28
  • In pts with meningitis
  • - most common bacteria S. pneumoniae (12/21
    pts)- CT showed that ethmoid and sphenoid
    sinuses were affected

29
  • Pansinusitis- predominant finding in the 16 pts
    with intracranial abscesses.
  • All pts underwent surgical drainage.

30
Types of local and distant complications of
sinusitis
  • Local
  • Intracranial complications
  • Meningitis
  • Epidural abscess
  • Subdural abscess
  • Intracerebral abscess
  • Pott's puffy tumor
  • Superior sagittal sinus thrombosis

31
Types of local and distant complications of
sinusitis
  • Local
  • Orbital complications
  • Periorbital cellulitis Extraconal
  • Orbital cellulitis (preseptal)
  • Subperiosteal abscess
  • Orbital abscess Intraconal
  • Cavernous sinus thrombosis (postseptal)
  • Mucocele

32
Types of local and distant complications of
sinusitis
  • Distant
  • Pulmonary (exacerbations of)
  • Asthma
  • Bronchitis
  • Chronic obstructive pulmonary disease Cystic
    fibrosis
  • Systemic diseases
  • Sepsis
  • Toxic shock syndrome
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