Pott's puffy tumour in a healthy adolescent following sinus barotrauma from underwater training

Pott’s puffy tumour (PPT) formation is a rare but serious complication of frontal sinusitis characterised by subperiosteal abscess and frontal bone osteomyelitis. While typically associated with untreated infection or direct head trauma, barosinusitis from high pressure underwater environments is a less recognised risk factor. In this case, a teenage boy with a history of intensive underwater training developed acute frontal headache and forehead swelling following upper respiratory illness. Imaging demonstrated frontal and ethmoid sinus opacification with subperiosteal abscess consistent with PPT. He underwent functional endoscopic sinus surgery with drainage and received targeted intravenous then oral antibiotics for methicillin-sensitive Staphylococcus aureus. His clinical course improved rapidly with no complications. This case highlights repetitive underwater training at high pressures as a precipitating factor for PPT in otherwise healthy adolescents. Clinicians should inquire about diving and other causes of sinus barotrauma when evaluating patients with refractory sinusitis and forehead swelling.