Department of Neurosurgery, Trauma Center, Gamma Knife Center, Cannizzaro Hospital, Catania, Italy.
Division of Neurosurgery, BIOMORF Department, University of Messina, Messina, Italy.
World Neurosurg. 2019 Nov;131:133-136. doi: 10.1016/j.wneu.2019.07.233. Epub 2019 Aug 7.
Primary, spontaneous, or de novo subgaleal abscesses represent extremely rare lesions usually related to patients with risk factors and predisposing conditions for infections. They are associated with high morbidity, and a proper diagnosis can be misleading. To the best of our knowledge, this is the first reported case of a de novo subgaleal abscess not related to previous traumatic head injury and associated with lung adenocarcinoma.
A 59-year-old man was admitted to our unit because he presented fever and a palpable subcutaneous right parietal mass. No history of traumatic head injury was mentioned. The patient underwent needle aspiration of the subgaleal lesion for microbiological, histological, and cytological examination, with negative response. Chest radiograph and then thoracic computed tomography scan revealed the presence of 2 lesions in the left lung. Complete removal with surgical debridement of the parietal bone lesion was performed due to the suspicion of an abscessualized skull metastasis from a primary lung adenocarcinoma.
We strongly suggest a patient global assessment in the event of subgaleal abscess without history of traumatic head injury, to treat eventual associated findings as soon as possible.
原发性、自发性或初发性帽状腱膜下脓肿是极为罕见的病变，通常与感染的危险因素和易患因素有关。它们与高发病率相关，正确的诊断可能会产生误导。据我们所知，这是首例与既往创伤性头部损伤无关且与肺腺癌相关的初发性帽状腱膜下脓肿的报道。
一名 59 岁男性因发热和可触及的右顶骨皮下肿块而被收入我院。未提及创伤性头部损伤史。对帽状腱膜下病变进行了针吸抽吸以进行微生物学、组织学和细胞学检查，结果为阴性。胸部 X 线和胸部 CT 扫描显示左肺有 2 个病变。由于怀疑原发性肺腺癌颅骨转移已脓肿形成，因此对顶骨病变进行了完全切除和清创术。
我们强烈建议在没有创伤性头部损伤史的情况下对帽状腱膜下脓肿患者进行全面评估，以便尽快治疗可能存在的相关发现。
