BRODIE’S ABCESSBRODIE’S ABCESS

Dr. ARUN. BDr. ARUN. B

Benjamin C. Brodie, English Benjamin C. Brodie, English

surgeon, 1783–1862surgeon, 1783–1862

Originally were described in the Originally were described in the tibial metaphyses by Brodie in tibial metaphyses by Brodie in 1832 1832

A chronic abscess of bone A chronic abscess of bone surrounded by dense fibrous tissue surrounded by dense fibrous tissue and sclerotic bone.and sclerotic bone.

Brodie's abscesses are especially Brodie's abscesses are especially

common in children, more typically common in children, more typically boysboys..

Chronic abscess resulting from Chronic abscess resulting from

incomplete resolution of acute incomplete resolution of acute osteomyelitis and isolation of the osteomyelitis and isolation of the infection by sclerotic bone.infection by sclerotic bone.

The condition is more common in The condition is more common in children than adults. The usual children than adults. The usual pathogen is Staphylococcus aureus but pathogen is Staphylococcus aureus but not infrequently no organism is isolated. not infrequently no organism is isolated.

Sequestra are not usually presentSequestra are not usually present Multiple abcess cavities may develop.Multiple abcess cavities may develop.

In this age group, they appear in the In this age group, they appear in the

metaphysis, particularly that of the metaphysis, particularly that of the distal or proximal portions of the distal or proximal portions of the tibia. tibia.

Less frequently, they occur in other Less frequently, they occur in other tubular, flat, or irregular bones, tubular, flat, or irregular bones, including the vertebral bodies, and including the vertebral bodies, and are diaphyseal in location. are diaphyseal in location.

Rarely, they traverse the open Rarely, they traverse the open growth plate, affecting the growth plate, affecting the epiphysis, although such epiphysis, although such extension does not commonly extension does not commonly result in growth disturbance. result in growth disturbance.

In young children and infants, In young children and infants, Brodie's abscesses may occur in Brodie's abscesses may occur in epiphyses and in the carpus and epiphyses and in the carpus and tarsus.tarsus.

Abscesses vary from less than 1 cm Abscesses vary from less than 1 cm

to over 4 cm in diameter. The wall of to over 4 cm in diameter. The wall of the abscess is lined by inflammatory the abscess is lined by inflammatory granulation tissue that is surrounded granulation tissue that is surrounded by spongy bone eburnation.by spongy bone eburnation.

The fluid in the abscess may be The fluid in the abscess may be purulent or mucoid 2; bacteriologic purulent or mucoid 2; bacteriologic examination of the fluid may or may examination of the fluid may or may not reveal the infecting organismsnot reveal the infecting organisms. .

Abcess mass consisting of cellular debris & Abcess mass consisting of cellular debris & neutrophils a surrounding fibrotic neutrophils a surrounding fibrotic reaction and peripheral eburnated bone.reaction and peripheral eburnated bone.

Radiographs outline radiolucency Radiographs outline radiolucency

with adjacent sclerosis .with adjacent sclerosis . Periosteal reaction may be present.Periosteal reaction may be present.

This lucent region commonly is This lucent region commonly is located in the metaphysis, where it located in the metaphysis, where it may connect with the growth plate may connect with the growth plate by a tortuous channel.by a tortuous channel.

Radiographic detection of this Radiographic detection of this channel is important; identification of channel is important; identification of a metaphyseal defect connected to a metaphyseal defect connected to the growth plate by such a tract the growth plate by such a tract ensures the diagnosis of ensures the diagnosis of osteomyelitis.osteomyelitis.

Such channels usually indicate a Such channels usually indicate a

pyogenic process and are uncommon pyogenic process and are uncommon in tuberculosis.in tuberculosis.

Patellar involvementPatellar involvement

X-ray & Transaxial CTX-ray & Transaxial CT

Appropriate antibiotic treatment in Appropriate antibiotic treatment in

children with metaphyseal abscesses children with metaphyseal abscesses may be accompanied by diminution may be accompanied by diminution in size and shaftward migration of in size and shaftward migration of the osteolytic focus.the osteolytic focus.

In the diaphysis, the radiolucent In the diaphysis, the radiolucent abscess cavity can be located in abscess cavity can be located in central or subcortical areas of the central or subcortical areas of the spongiosa or in the cortex itself and spongiosa or in the cortex itself and may contain a central sequestrum.may contain a central sequestrum.

In an epiphysis, a circular, well-defined In an epiphysis, a circular, well-defined

osteolytic lesion is seen, which, in the osteolytic lesion is seen, which, in the immature skeleton, may border on the immature skeleton, may border on the chondro-osseous junction or on the physis, chondro-osseous junction or on the physis, where it may extend into the metaphysis.where it may extend into the metaphysis.

When an abscess is located in the cortex, When an abscess is located in the cortex, its radiographic appearance, consisting of its radiographic appearance, consisting of a lucent lesion with surrounding sclerosis a lucent lesion with surrounding sclerosis and periostitis, simulates that of an and periostitis, simulates that of an osteoid osteoma or a stress fracture. osteoid osteoma or a stress fracture.

A circular or elliptical radiolucent A circular or elliptical radiolucent

lesion without calcification that is lesion without calcification that is smaller or larger than 2 cm is smaller or larger than 2 cm is characteristic of a cortical abscess; characteristic of a cortical abscess;

A circular lucent area with or without A circular lucent area with or without calcification smaller than 2 cm is calcification smaller than 2 cm is typical of an osteoid osteoma.typical of an osteoid osteoma.

A linear lucent shadow without A linear lucent shadow without calcification is characteristic of a calcification is characteristic of a stress fracture. stress fracture.

MR imaging shows high signal MR imaging shows high signal intensity of granulation tissue intensity of granulation tissue surrounded by low signal intensity of surrounded by low signal intensity of bone sclerosis.bone sclerosis.

Clinical symptoms are often mild, Clinical symptoms are often mild, generally presenting with persistent generally presenting with persistent local pain of several days duration local pain of several days duration with no systemic manifestations.with no systemic manifestations.

Swelling / tenderness /discharging Swelling / tenderness /discharging sinus may or may not be there.sinus may or may not be there.

Antibiotics are given accordingly.Antibiotics are given accordingly. Surgical drainage is necessary as Surgical drainage is necessary as

antibiotics will not penetrate the antibiotics will not penetrate the abscess cavity. abscess cavity.

Primary curettage and closure of the Primary curettage and closure of the woundwound

Not necessary to perform wide Not necessary to perform wide excision or saucerisation of the lesion.excision or saucerisation of the lesion.

Surgery is always indicated if large Surgery is always indicated if large cortical Sequestra and/or discharging cortical Sequestra and/or discharging sinuses are present.sinuses are present.