The insidious and often minimal development of symptoms in Brodie's abscess, an uncommon type of subacute osteomyelitis, frequently leads to a delayed diagnosis [1] [2] [3]. Defined as a well-demarcated intramedullary lytic abscess that does not cause bone enlargement, Brodie's abscess is principally diagnosed in the population under 25 years of age with a slight predilection toward male gender [1] [2] [4]. Previous trauma seems to be an important risk factor in the pathogenesis [2] [5]. Staphylococcus aureus is the main causative agent, but a number of gram-positive and gram-negative bacteria have been described in the literature as well, including Klebsiella pneumoniae, Pseudomonas aeruginosa, and coagulase-negative Staphylococci [1] [6]. The metaphysis of the lower extremities, particularly the tibia, is the predominant location of this lesion [2] [4] [6] [7]. The clinical presentation is centered around localized symptoms, such as pain, tenderness, and swelling of the part of the extremity overlying the abscess, while systemic signs (fever, chills, constitutional complaints, etc.) are absent in a vast number of patients [1] [2] [6]. In addition, pain and tenderness might last for months or even years before the diagnosis is made, which could be attributed to the subacute course of the disease, but also to a missed diagnosis [3].

• Painter

  PAINTER, M.D. * No preview is available for articles shorter than three pages. Facebook Twitter LinkedIn Email Copy URL Permissions Purchase this article Print Subscriber? Activate your online access. [nejm.org]

• Laboratory Technician

  The patient, a 29-year-old laboratory technician, sustained a closed, dorsally displaced distal radius fracture in January 2005 (Figure 1), when he had jumped out of a window. In his past medical history he presented with depression. [medcraveonline.com]

• Chronic Cough

  He had no history of prior trauma or chronic cough. There were no constitutional symptoms of either acute or chronic illness at the time of presentation. [pubs.sciepub.com]

• Hematochezia

  Haug Browse recently published Learning/CME Learning/CME View all learning/CME CME Partial Oral versus Intravenous Antibiotic Treatment of Endocarditis Case 4-2019: An 18-Year-Old Man with Abdominal Pain and Hematochezia Bridging the Gap Challenge Yourself [nejm.org]

• Systolic Murmur

  She had no systolic murmur or other specific findings. She undertook simple radiography and magnetic resonance imaging (MRI). [synapse.koreamed.org]

• Bone Disorder

  The book details the pathologic and radiologic characteristics of all bone and joint diseases, including arthritis, metastatic bone disease, osteoporosis, trauma, osteomyelitis, developmental bone disorders, and tumor-like lesions. [books.google.com]

  Second most common bone disorder after osteoporosis. 70-90% of persons with Paget disease are asymptomatic. Study the images and then continue reading. [radiologyassistant.nl]

Brodie's abscess can be hard to recognize. For this reason, a comprehensive workup is necessary for patients who present with symptoms suggesting a localized disease of the skeletal system, as neoplastic processes (both benign and malignant) are potential diagnoses [1]. Obtaining a detailed patient history is the first step, during which the course and progression of symptoms, as well as a history of recent trauma, should be assessed. After conducting a thorough physical examination and inspection of the affected extremity, imaging studies must be employed to establish an initial diagnosis. Plain radiography is a useful initial method for the evaluation of the skeleton, and typical findings that point toward Brodie's abscess are the presence of a well-defined soft-tissue mass that causes a geographical pattern of bone lysis, marginal sclerosis, and the absence of a periosteal reaction or bone enlargement [6] [7]. Furthermore, magnetic resonance imaging (MRI) is used for further diagnostic clarification, and the "penumbra sign" (the central part of the abscess shows a low T1 signal intensity and a high T2 signal intensity, whereas the outer layer is always hypointense) is considered to be a highly specific, although not pathognomonic, feature of Brodie's abscess [5] [6]. In addition to imaging procedures, microbiological testing in the form of blood cultures (or cultivation of the material obtained from the abscess itself) is also recommended, but studies report that between 20-80% of cultures yield negative results [1] [2] [6].

• Salmonella Typhi

  Key words: Abscess; Osteomyelitis; Salmonella typhi View this abstract indexed in MEDLINE: [hkmj.org]

  Salmonella Typhi is the most frequent isolate in these infections[ 3, 4 ]. [synapse.koreamed.org]

  Brodie’s abscess of the ulna caused by Salmonella typhi. Hong Kong Med J 2008;14(2):154-6. 8. Olasinde AA, Oluwadiya KS, Adegbehingbe OO. Treatment of Brodie’s abscess: Excellent results from curettage, bone grafting and antibiotics. [jocr.co.in]

  Ip KC, Lam YL, Chang RY (2008) Brodie's abscess of the ulna caused by Salmonella typhi. Hong Kong Med J 14(2): 154-156. [medcraveonline.com]

1. Qi R, Colmegna I. Brodie abscess. CMAJ. 2017;189(3):E117.
2. Olasinde AA, Oluwadiya KS, Adegbehingbe OO. Treatment of Brodie’s abscess: excellent results from curettage, bone grafting and antibiotics. Singapore Med J 2011;52:436–439.
3. Agrawal P, Sobti A. A Brodie’s Abscess of Femoral Neck Mimicking Osteoid Osteoma: Diagnostic Approach and Management Strategy. Ethiopian Journal of Health Sciences. 2016;26(1):81-84.
4. Contreras MA, Andreu JL, Mulero J, González C. Brodie's abscess with a fistulous tract connecting with the joint space. Arthritis Rheum. 2000;43(12):2848-2850.
5. Afshar A, Mohammadi A. The “Penumbra Sign” on Magnetic Resonance Images of Brodie’s Abscess: A Case Report. Iran J Radiol. 2011;8(4):245-248
6. Johnson JW, Bindra RR. Brodie’s Abscess of the Distal Radius: An Unusual Complication after Percutaneous Pinning. Hand (N Y). 2008;3(4):381-384.
7. Lopes TD, Reinus WR, Wilson AJ. Quantitative analysis of the plain radiographic appearance of Brodie’s abscess. Invest Radiol. 1997;32(1):51–58.