Introduction: Brodie's abscess is a form of osteomyelitis. Since its first appearance in the medical literature in 1832, numerous cases have been described. The aim of this article is to provide the first comprehensive overview of published cases of Brodie's abscess, and to describe diagnostic methods, therapeutic consequences and outcomes. Methods: According to PRISMA guidelines a systematic review of the literature was performed. All published data in English or Dutch were considered for inclusion with no limitations on publication date. Data was extracted on demography, duration of symptoms, signs of inflammation, diagnostic imaging, causative agent, treatment and follow-up. Results: A total of 70 articles were included, reporting on a total of 407 patients, mostly young (median age 17) males (male:female ratio 2.1:1). The median duration of symptoms before diagnosis was 12 weeks (SD 26). Mostly consisting of pain (98%) and/or swelling (53%). 84% of all patients were afebrile, and less than 50% had elevated serum inflammation markers. Diagnosis was made with a combination of imaging modalities: plain X-ray in 96%, MRI (16%) and CT-scan (8%). Treatment consisted of surgery in 94% of the cases, in conjunction with long term antibiotics in 77%. Staphylococcus aureus was the pathogen most often found in the culture (67,3%). Outcome was generally reported as favorable. Recurrence was reported in 15,6% of the cases requiring further intervention. Two cases developed permanent disability. Conclusion: Brodie's abscess has an insidious onset as systemic inflammatory signs and symptoms were often not found. Treatment consisted mostly of surgery followed by antibiotics (77%) or only surgery (17%) and outcomes were generally reported as favourable.

/pdf/brodie-s-abscess-a-systematic-review-of-reported-cases-31fzmzcl79.pdf

Brodie's Abscess: A Systematic Review of Reported Cases.

The treatment of musculoskeletal neoplasms and infection is usually based on an initial diagnostic biopsy.Prior to biopsy, a hypothesis should be formed about the most likely diagnosis and a differential diagnosis. These deliberations should consider whether the lesion is a primary benign or malignant tumour, a metastasis, a haematological problem or an infection.A tactical plan should be developed which evaluates the necessity, the risk, the approach and finally defines the technique of biopsy most likely to achieve a representative result in the clinical case.In developing this technical approach, the pitfalls should be anticipated, i.e. inadequate sampling, difficulty of pathological interpretation and contamination.The tactical approach should be developed in conjunction with a multi-disciplinary team together with appropriate pre-biopsy imaging. Cite this article: EFORT Open Rev 2017;2:51-57. DOI: 10.1302/2058-5241.2.160065.

The tactics and technique of musculoskeletal biopsy.

Atraumatic limb pain and limp is a common pediatric presentation in the emergency department in the United States. In a majority of cases, these presentations are benign. However, in cases where pediatric patients are repeatedly presenting for atraumatic limb pain, further investigation is required. We present such the case of a 14-year-old female with acute worsening of progressive atraumatic knee pain who was found to have a Brodie's abscess, a subacute pyogenic form of osteomyelitis. This is a particularly challenging diagnosis, as it often presents with no associated symptoms such as fever or weight loss. The consequences of missing this diagnosis include permanent disability and potential amputation, but excellent outcomes can be expected for those who undergo timely surgical debridement and irrigation. We discuss the etiology, common presentations, and treatment of this rare but potentially limb-threatening disease in the hope that clinicians will consider this diagnosis in cases of persistent or progressive atraumatic limb pain.

/pdf/a-case-of-brodie-s-abscess-with-tibial-erosion-and-2ay9770m8t.pdf

A Case of Brodie's Abscess With Tibial Erosion and Extravasation Into Surrounding Soft Tissue.

/pdf/primary-bone-lymphoma-of-the-distal-tibia-mimicking-brodie-s-11z1uhglhl.pdf

Primary Bone Lymphoma of the Distal Tibia Mimicking Brodie's Abscess

Brodie’s abscess, a localized type of subacute or chronic osteomyelitis, may be difficult to differentiate from benign or malignant bone tumors (1). The “penumbra sign” on an unenhanced T1-weighted image is a well-known characteristic of Brodie’s abscess. It is seen on T1-weighted MR images as a rim lining the abscess cavity with a higher signal intensity than that of the main abscess. It is considered to be extremely helpful for discriminating subacute osteomyelitis from other bone lesions, although it is not pathognomonic. We describe a case of histopathologically confirmed primary diffuse large B-cell lymphoma of the distal tibia with a positive penumbra sign on MRI. To our knowledge this is the first report of a primary bone lymphoma that shows the finding of a penumbra sign on an MRI.

Primary Bone Lymphoma of the Distal Tibia Mimicking Brodie's

High-grade chondrosarcoma mimicking Brodie's abscess.

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High-grade chondrosarcoma mimicking Brodie's abscess.