<aside>
Brodie abscess is a localized, chronic, intraosseous abscess typically resulting from subacute or chronic osteomyelitis.
</aside>
| Factor | Description |
|---|---|
| Cause | Usually ‣ infection |
| Pathogenesis | Low-grade infection leads to localized pus collection within bone, surrounded by sclerotic bone wall (immune response) |
| Predisposing factors | Minor trauma, hematogenous spread, recent infection or bacteremia |
| Feature | Description |
|---|---|
| Age | Common in children and adolescents |
| Symptoms | Dull, localized pain (may be worse at night), often no fever or systemic signs |
| Physical findings | Localized tenderness, possible swelling; often minimal |
| Labs | ESR and CRP may be normal or mildly elevated; WBC often normal |
IV. Common Locations
https://doi.org/10.1016/j.radcr.2021.07.001
| Modality | Imaging features |
|---|---|
| XR | • Oval or round lytic lesion in metaphysis or cortex |
| • Thick sclerotic rim (reactive bone) | |
| • Sequestrum (central dense bone fragment) may be seen | |
| • No periosteal reaction in chronic cases | |
| CT | • Delineating cortical involvement |
| • Detecting sequestrum | |
| • Assessing sclerotic margin | |
| MR | • T1: Central low signal (fluid), rim of low signal (sclerosis) |
| • T2/STIR: Hyperintense abscess cavity, surrounding edema | |
| • Post-contrast: Peripheral rim enhancement (abscess wall) | |
| • May show surrounding marrow edema and soft tissue involvement | |
| • **Penumbra sign (**T1-W MRI): A thin inner rim of high signal intensity surrounding the low-signal cavity – suggestive but not specific. | |
| Nuclear medicine | • Bone scan: Increased uptake at affected site |
| • May help identify multifocal infection |
Initial imaging examination. (A) AP plain radiograph of the left knee shows no significant signs of abnormalities. (B, C) MRI of the left knee. Coronal view of T1 and T2FS images. Bone marrow edema around the pes anserinus and fluid accumulation below the medial collateral ligament are observed. (D, E) Another imaging slice of coronal and sagittal view of T2FS images. There was a space occupied lesion at the metaphyseal growth plate and it was considered a micro-abscess retrospectively.
Kamio S, Arai M, Matsumoto S, Saito M, Asano N, Nakayama R. Radiological changes in the formation of Brodie’s abscess by sequential magnetic resonance imaging: a case report. Radiology Case Reports. 2021;16(10):2993-2997. doi:https://doi.org/10.1016/j.radcr.2021.07.001
Second imaging examination 1 month after the initial examination. (A) AP plain radiograph of the left knee shows the osteolytic lesion on the medial side of the tibial metaphysis. (B, C) MRI of the left knee. Coronal view of T1 and T2FS images. An osteolytic lesion is detected. The central part of the lesion has a low signal intensity on T1-weighted images and high signal intensity on fat-suppressed T2-weighted images, which suggested pus accumulation.
Kamio S, Arai M, Matsumoto S, Saito M, Asano N, Nakayama R. Radiological changes in the formation of Brodie’s abscess by sequential magnetic resonance imaging: a case report. Radiology Case Reports. 2021;16(10):2993-2997. doi:https://doi.org/10.1016/j.radcr.2021.07.001
X-ray showing osteocondensation (arrows) and regular bone lysis (asterisk) of the middle third of tibial diaphysis.
Zairi M, Rim Boussetta, Msakni A, Mohseni AA, Nessib MN. Subacute osteomyelitis of the tibial diaphysis associated with Brodie’s abscess: A rare case report of a four-year-old child. International Journal of Surgery Case Reports. 2021;89:106453-106453. doi:https://doi.org/10.1016/j.ijscr.2021.106453
Brodie's abscess on MRI: Heterogeneous signal from the medulla of the middle third of the tibial shaft accompanied by thickening of the cortex and infiltration of soft tissues (arrows). Intramedullary oval formation enhancing after injection of Gadolinium (asterisk).
Zairi M, Rim Boussetta, Msakni A, Mohseni AA, Nessib MN. Subacute osteomyelitis of the tibial diaphysis associated with Brodie’s abscess: A rare case report of a four-year-old child. International Journal of Surgery Case Reports. 2021;89:106453-106453. doi:https://doi.org/10.1016/j.ijscr.2021.106453