Aimee双语小讲堂 第四讲：波特氏头皮肿块

Aimee   上海某医院

History and CT images

History: A teenage patient presents with head pain.

病史：青少年患者，因头痛就诊

CT images are shown below. Click to enlarge.

Findings

Extensive pan sinus disease with a thin layer of abscess along the outer table of the left frontal bone, as well as extensive soft-tissue swelling of the forehead, is seen, consistent with frontal bone osteomyelitis. Tiny medial left frontal pneumocephalus is consistent with intracranial extension of infection and likely presence of a tiny epidural abscess.

影像学表现

泛副鼻窦炎伴左侧额骨外侧薄层脓肿，同时可见额部广泛软组织肿胀，由额骨骨髓炎引发。颅内感染播散引发左侧额部少量积气。同时可见少量硬膜外脓肿。

Differential diagnosis 鉴别诊断

· Pott's puffy tumor波特氏头皮肿块

· Ewing's sarcoma尤文肉瘤

· Langerhans cell histiocytosis朗格汉斯组织细胞增生症

· Lymphoma 淋巴瘤

Diagnosis: Pott's puffy tumor of scalp 波特氏头皮肿块

Key points

Pott's puffy tumor of the scalp

· Pott's puffy tumor was first described in 1760 by English surgeon Sir Percival Pott. It is a complication of bacterial frontal sinusitis.

· 1760年英国外科医生Percival Pott爵士发现了波特氏头皮肿块。是由细菌性额头炎的并发症。

· Calvarial: Subgaleal abscess forms over osteomyelitis; usually due to frontal sinusitis. Infected cephalohematoma.

· 颅顶的：腱膜下脓肿沿骨髓炎累及区域分布；常由额窦炎引发。感染性头颅血肿。

· Earliest image findings:

· Soft-tissue swelling next to bone

· Displacement or obliteration of fat planes

超早期表现：骨旁软组织肿胀；脂肪层移位或消失

· Bony destruction is seen seven to 14 days (or longer) after onset.

· Vague lucency -> permeation -> destruction

· Periosteal reaction at seven to 10 days

· 病程开始后7-14天出现骨质破坏

· 骨小梁模糊→穿通→破坏

· 7-10天出现骨膜反应。

· Chronic osteomyelitis: Sclerosis or mixed sclerotic/lucent, lucent tract extending through cortex, sequestrum (radiodense)

· 慢性骨髓炎：硬化性或同时存在硬化/透亮，透亮影通过骨皮质、伴有死骨

· CT:

· Bone destruction, intracerebral gas and fat-fluid level, periosteal reaction, sequestrum

· Rim enhancement of intra- and extraosseous abscesses

· Bony destruction/sclerosis

· Surrounding soft-tissue swelling

· May show lucent tract through cortex, bony sequestrum

CT：

· 骨质破坏、颅内气体和脂液平，骨膜反应，可见死骨。

· 骨内、骨外脓肿可见环形强化。

· 骨破坏/硬化

· 周围软组织肿胀。

· 可见骨皮质透亮影，伴有死骨。

MRI:

· Marrow edema, enhancement

· Abscess: Peripheral enhancement/central nonenhancement

· Large areas of surrounding edema in soft tissue/marrow

· Well-defined areas that do not enhance with gadolinium, suspect necrosis or abscess formation

MRI：

· 骨髓水肿伴强化

· 脓肿：周边强化、中央无明显强化。

· 软组织、骨髓周围大片水肿

· 边界清晰病灶，未见明显强化，可能是坏死或脓肿。