A pyocele of the frontal sinus as a complication of chronic sinusitis – a case report

Abstract

Introduction: Pyocele is a rare complication of sinusitis that is usually associated with stenosis of the ostium of the sinus caused by inflammation, trauma. Case report: A 68-year-old woman was admitted to the Otolaryngology Clinical Department of the University Hospital in Krakow, Poland because of a tumor of the right frontal bone which was painful during palpation. In anamnesis the patient reported previous laryngological surgeries associated with the treatment of chronic sinusitis. The conducted medical imaging presented the destruction of the walls of both the right and left frontal sinuses caused by pathological changes penetrating to the orbit and adhering to the dura mater. The clinical and radiological picture suggested the diagnosis of empyema of the paranasal sinus (pyocele). The patient was scheduled for bilateral endoscopic frontoethmoidectomy and the surgery ended without complications. Nowadays, the patient remains under follow-up in the outpatient otolaryngology clinic. Discussion: The main disease entity, which should be included in the differential diagnosis of pyocele is the retention cyst of the sinus. The vast majority of pyocele cases are caused by superinfection of a mucocele by bacteria (in the described case the bacterial culture of the lesion content revealed the presence of Citrobacter koseri). An efficient and sufficient method of treatment of pyocele of paranasal sinuses is their endoscopic drainage. Conclusion: In the diagnosis of pyocele, the most important are data from anamnesis, physical examination and results from computed tomography and magnetic resonance imaging. Treatment is mainly based on properly performed surgery, pharmacotherapy and consecutive rehabilitation. Endoscopic surgery is an effective procedure and its early use often prevents serious complications resulting from the expansion of the lesion.