2. Benjamin C. Brodie, English
surgeon, 1783–1862
Originally were described in the
tibial metaphyses by Brodie in 1832
3. A chronic abscess of bone surrounded
by dense fibrous tissue and sclerotic
bone.
Brodie's abscesses are especially
common in children, more typically boys.
4. Chronic abscess resulting from
incomplete resolution of acute
osteomyelitis and isolation of the
infection by sclerotic bone.
The condition is more common in
children than adults. The usual pathogen
is Staphylococcus aureus but not
infrequently no organism is isolated.
Sequestra are not usually present
Multiple abcess cavities may develop.
5. In this age group, they appear in the
metaphysis, particularly that of the
distal or proximal portions of the tibia.
Less frequently, they occur in other
tubular, flat, or irregular
bones, including the vertebral
bodies, and are diaphyseal in location.
6. Rarely, they traverse the open
growth plate, affecting the
epiphysis, although such extension
does not commonly result in growth
disturbance.
In young children and
infants, Brodie's abscesses may
occur in epiphyses and in the carpus
and tarsus.
7. Abscesses vary from less than 1 cm to
over 4 cm in diameter. The wall of the
abscess is lined by inflammatory
granulation tissue that is surrounded by
spongy bone eburnation.
The fluid in the abscess may be purulent
or mucoid 2; bacteriologic examination
of the fluid may or may not reveal the
infecting organisms.
8. Abcess mass consisting of cellular debris &
neutrophils a surrounding fibrotic reaction
and peripheral eburnated bone.
9. Radiographs outline radiolucency with
adjacent sclerosis .
Periosteal reaction may be present.
This lucent region commonly is located
in the metaphysis, where it may connect
with the growth plate by a tortuous
channel.
10. Radiographic detection of this channel
is important; identification of a
metaphyseal defect connected to the
growth plate by such a tract ensures
the diagnosis of osteomyelitis.
Such channels usually indicate a
pyogenic process and are uncommon in
tuberculosis.
17. Appropriate antibiotic treatment in
children with metaphyseal abscesses
may be accompanied by diminution in
size and shaftward migration of the
osteolytic focus.
In the diaphysis, the radiolucent
abscess cavity can be located in central
or subcortical areas of the spongiosa or
in the cortex itself and may contain a
central sequestrum.
18. In an epiphysis, a circular, well-defined
osteolytic lesion is seen, which, in the
immature skeleton, may border on the
chondro-osseous junction or on the
physis, where it may extend into the
metaphysis.
When an abscess is located in the cortex, its
radiographic appearance, consisting of a
lucent lesion with surrounding sclerosis and
periostitis, simulates that of an osteoid
osteoma or a stress fracture.
19. A circular or elliptical radiolucent lesion
without calcification that is smaller or
larger than 2 cm is characteristic of a
cortical abscess;
A circular lucent area with or without
calcification smaller than 2 cm is typical
of an osteoid osteoma.
A linear lucent shadow without
calcification is characteristic of a
stress fracture.
20. MR imaging shows high signal intensity
of granulation tissue surrounded by low
signal intensity of bone sclerosis.
21. Clinical symptoms are often
mild, generally presenting with
persistent local pain of several days
duration with no systemic
manifestations.
Swelling / tenderness /discharging sinus
may or may not be there.
22. Antibiotics are given accordingly.
Surgical drainage is necessary as
antibiotics will not penetrate the
abscess cavity.
Primary curettage and closure of the
wound
Not necessary to perform wide excision
or saucerisation of the lesion.
Surgery is always indicated if large
cortical Sequestra and/or discharging
sinuses are present.
