0
Special Feature |

Picture of the Month—Quiz Case FREE

Marc Tebruegge, MRCPCH, MD; Nigel Curtis, FRCPCH, PhD; David Wallace, FRACS; Mike Starr, FRACP; Penelope Bryant, MRCPCH, PhD
[+] Author Affiliations

Section Editor: Samir S. Shah, MD, MPH
Author Affiliations:Infectious Diseases Unit, Department of General Medicine (Drs Tebruegge, Curtis, Starr, and Bryant), Department of Neurosurgery (Mr Wallace), Department of Pediatrics, The University of Melbourne (Drs Tebruegge, Curtis, and Bryant), and Murdoch Children's Research Institute (Drs Tebruegge, Curtis, and Bryant), Royal Children's Hospital Melbourne, Parkville, Victoria, Australia.


Arch Pediatr Adolesc Med. 2010;164(3):289. doi:10.1001/archpediatrics.2010.2-a.
Text Size: A A A
Published online

A previously well 16-year-old boy presented to his local hospital with intermittent pyrexia, diffuse headache, and a left-sided swelling that had gradually enlarged over the previous 7 days. Two weeks earlier, his general practitioner had diagnosed sinusitis and had prescribed a combination of amoxicillin and clavulanate, administered orally, which the patient only partially completed.

Results of a physical examination revealed a large, tender, fluctuant lesion in the left parietal region of the skull. The remainder of the examination was unremarkable.

A computed tomographic scan of the head showed a large extracranial subgaleal abscess corresponding to the site of the swelling (Figure 1) and osteomyelitis of the underlying skull. The abscess was drained locally, and the patient was transferred to our center for further treatment.

Place holder to copy figure label and caption
Figure 1.

Cranial computed tomographic scan showing the left-sided extracranial abscess and osteolytic lesions indicative of osteomyelitis (arrow). L indicates left; P, posterior; and R, right.

Graphic Jump Location

On admission, the cranial magnetic resonance (MR) image showed mucosal swelling and opacities in his maxillary, ethmoid, and frontal sinuses bilaterally indicating pansinusitis. An unexpected abnormality was also detected (Figure 2).

Place holder to copy figure label and caption
Figure 2.

T2-weighted (A) and T1-weighted (B) cranial magnetic resonance images. The findings are described in detail in the “Denouement and Discussion” section.

Graphic Jump Location

Figures

Place holder to copy figure label and caption
Figure 1.

Cranial computed tomographic scan showing the left-sided extracranial abscess and osteolytic lesions indicative of osteomyelitis (arrow). L indicates left; P, posterior; and R, right.

Graphic Jump Location
Place holder to copy figure label and caption
Figure 2.

T2-weighted (A) and T1-weighted (B) cranial magnetic resonance images. The findings are described in detail in the “Denouement and Discussion” section.

Graphic Jump Location

Tables

References

Correspondence

CME
Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).
Submit a Comment

Multimedia

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.

See Also...
Articles Related By Topic
Related Topics
PubMed Articles
Recurrent midline frontal mass in a patient with sinusitis. Clin Pediatr (Phila) 2011;50(3):266-8.
[Pott's puffy tumor - severe course of a sinusitis]. Praxis (Bern 1994) 2010;99(9):555-60.