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].

• Soft Tissue Swelling

  […] of the bone surrounded by a thick dense rim of reactive sclerosis that fades imperceptibly into surrounding bone lucent tortuous channel extending toward growth plate prior to physeal closure (pathognomonic) periosteal new-bone formation +/- adjacent soft-tissue [radiopaedia.org]

  There was marked increase in thickness of the cortices of the proximal one-third of tibia with associated mild overlying soft tissue swelling. [pubs.sciepub.com]

  […] to 15 years who experienced pain, soft tissue swelling, decreased range of motion, and increased sedimentation rate.6 Radiographically, they all had small lytic metaphyseal lesions often adjacent to the physis predominantly in the distal femurs, clavicle [healio.com]

  Soft tissues – the muscles appear to be of normal size with no obvious wasting or swelling; the joint capsule appears normally indistinct with no effusion or hemorrhage noted; the periosteum also appears normal indistinct; no foreign bodies, gas bubbles [authorstream.com]

• 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]

• 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]

• Suggestibility

  Axial T1-weighted MRI pre-contrast enhancement showing that the intramedullary collection is T1-hyperintense suggesting proteinaceous viscous fluid consistent with infection. [en.wikipedia.org]

  Although primarily a diagnostic aid, the text includes therapeutic suggestions. A glossary defines specific orthopaedic disorders. [books.google.com]

  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. [symptoma.com]

  There is a suggestion of invagination of the midportton of both distal femoral epiphyses into the metaphyses, suggesting central fusion of the physis. References 1. Brodie BC: An account of some cases of chronic abscess of the tibia. [healio.com]

• Type A Personality

  He does not feel sleepy and his parents describe him as a night person. - He is generally better from massage. Psychological: He is a dreamy type of person, always having fantasies of what he would do after school-time. [interhomeopathy.org]

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]

Radiofrequency ablation (RFA) therapy is recognised as a safe and effective treatment option for osteoid osteoma. [biij2.org]

Handoll HH et al. [9] External fixation versus conservative treatment for distal radial fractures in adults. Handoll HHG, Huntley JS, Madhok R. External fixation versus conservative treatment for distal radial fractures in adults. [medcraveonline.com]

Make informed clinical choices for each patient, from diagnosis and treatment selection through post-treatment strategies and management of complications, with new evidence-based criteria throughout. [books.google.com]

This is when Brodie hypothesized that limb sparing surgery by means of trephination and thus drainage of the abscess should be the cornerstone of treatment. In this pre-antibiotic era this was the only treatment option available. [ncbi.nlm.nih.gov]

We describe the radiologic and diagnostic features of this osteomyelitis and outline its management and prognosis. To our knowledge, this is the first report of such a case with this unusual presentation. [ncbi.nlm.nih.gov]

Diagnosis and Prognosis: Diagnosis and Prognosis Diagnosis Usually difficult to diagnose because the characteristic signs and symptoms of the acute (osteomyelitis) form of the disease are absent. 1 Diagnosis can be prolonged from 1 month to 2 years. 4 [authorstream.com]

[…] surgical debridement of necrotic bone, weakened host defenses May develop sinus tract lined by squamous epithelium that forms large epidermal inclusion cyst within bone; rarely transforms to well differentiated squamous cell carcinoma with excellent prognosis [pathologyoutlines.com]

[…] outer layer of new bone is formed by the periosteum (involucrum) involucrum a layer of new bone growth outside existing bone seen in osteomyelitis chronic abscesses may become surrounded by sclerotic bone and fibrous tissue leading to a Brodie's abscess Prognosis [orthobullets.com]

In the 1830s, he initially described a chronic inflammatory condition affecting the tibia without obvious acute etiology. [1] It was later discovered that this was caused by infection. References [ edit ] ^ McHugh, C. H.; Shapeero, L. [en.wikipedia.org]

Etiology S. aureus (most common); cultures often negative Location It has a predilection for ends (metaphysis) of tubular bones: proximal/distal tibial metaphysis (most common) carpal and tarsal bones Rarely traversing the open growth plate; epiphysis [radiopaedia.org]

Etiology The specific microorganism(s) isolated from patients with bacterial osteomyelitis is often associated with the age of the patient or the clinical scenario ( Tables 5 15 and 6 16 ). [aafp.org]

The etiologic pathogen of Brodie's abscess is mostly Staphylococcus aureus but sterile cultures were found in about 25%[ 2, 9, 10 ]. [synapse.koreamed.org]

Introduction Overview pediatric osteomyelitis is most often the result of hematogenous seeding of bacteria to the metaphyseal region of bone treatment is usually antibiotics with or without surgical drainage Epidemiology incidence 1 in 5000 children younger [orthobullets.com]

Epidemiological, Clinical and Microbiological Characteristics of Patients with Post-Traumatic Osteomyelitis of Limb Fractures in Southwest China: A Hospital-Based Study. J bone Jt Infect. [ncbi.nlm.nih.gov]

Epidemiological, Clinical and Microbiological Characteristics of Patients with Post-Traumatic Osteomyelitis of Limb Fractures in Southwest China: A Hospital-Based Study. J bone Jt Infect. Australia. 2017;2(3):149-53 5. Lew DP, Waldvogel FA. [jbji.net]

EPIDEMIOLOGY Infection by S. aureus is the most common cause of osteomyelitis. Community acquired S. aureus is implicated in most cases with 30% of these cases caused by community acquired MRSA (CA-MRSA)[ 4, 5 ]. [wjgnet.com]

Brodie abscess : Small intraosseous abscess in cortex, walled off by reactive bone with no periosteal reaction Cavity may contain infectious organisms or be sterile May have late recrudescence Therapy: total surgical excision ( Tunis Med 2007;85:857 ) Pathophysiology [pathologyoutlines.com]

The pathophysiologic explanation for the local abscess collection is thought to be due to balanced host and bacteria defenses—the abscess is walled-off, minimizing systemic response 3. [pubs.sciepub.com]

[…] supply and immature immune system not uncommon in healthy children location typically metaphyseal via hematogenous seeding risk factors diabetes mellitus hemoglobinopathy rheumatoid arthritis chronic renal disease immune compromise varicella infection Pathophysiology [orthobullets.com]

PATHOPHYSIOLOGY Hematogenous osteomyelitis is the most common type of osteomyelitis in children[ 4 ]. This occurs when an infection elsewhere in the body spreads to the bone via the bloodstream. [wjgnet.com]

First surgical operation was conducted on 30th April 2004; lateral side of the right calcaneous was opened and debridement of muscle and bone was carried out and the lesion closed with a ‘sulmycin-sponge implant' on vacuum assisted closure for local prevention [ispub.com]

It is hard to determine anything in the first days on onset but it is crucial to detect the infections to prevent further infection and problems, leading to increased dysfunction. [authorstream.com]

It was initially painless but he started to experience occasional dull achy pains few months prior to presentation, which did not prevent him from performing his routine daily activities. He had no history of prior trauma or chronic cough. [pubs.sciepub.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.