Brodie abscess | |
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Axial T1-weighted MRI image through the distal tibia showing Brodie abscess. | |
Specialty | Orthopedic surgery |
A Brodie abscess is a subacute osteomyelitis, appearing as an accumulation of pus in bone, frequently with an insidious onset. [1] Brodie's abscess is characterized by pain and swelling without fever, often resulting from diabetic wounds, fracture-related bone infection, or haematogenous osteomyelitis.
The condition is often diagnosed through imaging, which reveals distinctive "target signs" such as central necrosis, surrounding granulation tissue, fibrosis, and an outermost layer of oedema. A biopsy can rule out other possible diagnoses, such as bone tumors.
Surgery is the main treatment, often combined with antibiotics. The prognosis is generally favorable, with minimal risk of lasting disability or recurrence.
Brodie abscess is responsible for 2.5%-42% of primary bone infections. It is named after Sir Benjamin Collins Brodie, 1st Baronet, who initially described the condition in the 1830s.
Brodie's abscess causes a collection of pus in the bone causing pain and swelling. [2] There is usually no signs or symptoms of a systematic disease. [3] Brodie's abscess usually occurs in the tibia or femur. [1]
When it comes to bone infections, there exist multiple etiologies: exposed bone in diabetic wounds, fracture-related bone infection following (open) trauma, [4] [5] or haematogenous osteomyelitis. [6] [7] Causative organisms include Staphylococcus aureus, Pseudomonas, Klebsiella, and coagulase-negative Staphylococcus. [3]
Since patients frequently appear with pain and swelling without a fever, diagnosis can be difficult. Blood cultures and inflammatory indicators are frequently non-revealing, hence a high level of suspicion is required to diagnose this type of osteomyelitis. When diagnosing Brodie's abscess, imaging is crucial. The "target sign" on MRI, which includes central necrosis, surrounding granulation tissue, fibrosis or sclerosis, and an outermost layer of oedema, is distinctive. A biopsy can be useful in ruling out other possible diagnoses, like a bone tumor. [2]
A variety of benign and malignant bone abnormalities, including as cysts, osteoid osteoma, giant cell tumors, chondroblastomas, and Ewing sarcoma, are included in the differential diagnosis of Brodie abscess. [3]
Surgery was the main form of treatment, frequently in conjunction with antibiotics. [1]
The prognosis is usually favorable, with very little likelihood of a lasting disability or recurrence. [1]
Brodie abscess is responsible for 2.5%–42% of primary bone infections. [3]
Brodie abscess is named after Sir Benjamin Collins Brodie, 1st Baronet. In the 1830s, he initially described a chronic inflammatory condition affecting the tibia without obvious acute etiology. [8]
An abscess is a collection of pus that has built up within the tissue of the body. Signs and symptoms of abscesses include redness, pain, warmth, and swelling. The swelling may feel fluid-filled when pressed. The area of redness often extends beyond the swelling. Carbuncles and boils are types of abscess that often involve hair follicles, with carbuncles being larger. A cyst is related to an abscess, but it contains a material other than pus, and a cyst has a clearly defined wall.
Brain abscess is an abscess within the brain tissue caused by inflammation and collection of infected material coming from local or remote infectious sources. The infection may also be introduced through a skull fracture following a head trauma or surgical procedures. Brain abscess is usually associated with congenital heart disease in young children. It may occur at any age but is most frequent in the third decade of life.
An osteosarcoma (OS) or osteogenic sarcoma (OGS) is a cancerous tumor in a bone. Specifically, it is an aggressive malignant neoplasm that arises from primitive transformed cells of mesenchymal origin and that exhibits osteoblastic differentiation and produces malignant osteoid.
Acute septic arthritis, infectious arthritis, suppurative arthritis, pyogenic arthritis, osteomyelitis, or joint infection is the invasion of a joint by an infectious agent resulting in joint inflammation. Generally speaking, symptoms typically include redness, heat and pain in a single joint associated with a decreased ability to move the joint. Onset is usually rapid. Other symptoms may include fever, weakness and headache. Occasionally, more than one joint may be involved, especially in neonates, younger children and immunocompromised individuals. In neonates, infants during the first year of life, and toddlers, the signs and symptoms of septic arthritis can be deceptive and mimic other infectious and non-infectious disorders.
Osteomyelitis (OM) is an infection of bone. Symptoms may include pain in a specific bone with overlying redness, fever, and weakness. The long bones of the arms and legs are most commonly involved in children e.g. the femur and humerus, while the feet, spine, and hips are most commonly involved in adults.
Cellulitis is usually a bacterial infection involving the inner layers of the skin. It specifically affects the dermis and subcutaneous fat. Signs and symptoms include an area of redness which increases in size over a few days. The borders of the area of redness are generally not sharp and the skin may be swollen. While the redness often turns white when pressure is applied, this is not always the case. The area of infection is usually painful. Lymphatic vessels may occasionally be involved, and the person may have a fever and feel tired.
Eumycetoma, also known as Madura foot, is a persistent fungal infection of the skin and the tissues just under the skin, affecting most commonly the feet, although it can occur in hands and other body parts. It starts as a painless wet nodule, which may be present for years before ulceration, swelling, grainy discharge and weeping from sinuses and fistulae, followed by bone deformity.
An epidural abscess refers to a collection of pus and infectious material located in the epidural space superficial to the dura mater which surrounds the central nervous system. Due to its location adjacent to brain or spinal cord, epidural abscesses have the potential to cause weakness, pain, and paralysis.
Ludwig's angina is a type of severe cellulitis involving the floor of the mouth and is often caused by bacterial sources. Early in the infection, the floor of the mouth raises due to swelling, leading to difficulty swallowing saliva. As a result, patients may present with drooling and difficulty speaking. As the condition worsens, the airway may be compromised and hardening of the spaces on both sides of the tongue may develop. Overall, this condition has a rapid onset over a few hours.
Orbital cellulitis is inflammation of eye tissues behind the orbital septum. It is most commonly caused by an acute spread of infection into the eye socket from either the adjacent sinuses or through the blood. It may also occur after trauma. When it affects the rear of the eye, it is known as retro-orbital cellulitis.
A dental abscess is a localized collection of pus associated with a tooth. The most common type of dental abscess is a periapical abscess, and the second most common is a periodontal abscess. In a periapical abscess, usually the origin is a bacterial infection that has accumulated in the soft, often dead, pulp of the tooth. This can be caused by tooth decay, broken teeth or extensive periodontal disease. A failed root canal treatment may also create a similar abscess.
Pott's puffy tumor, first described by Sir Percivall Pott in 1760, is a rare clinical entity characterized by subperiosteal abscess associated with osteomyelitis. It is characterized by an osteomyelitis of the frontal bone, either direct or through haematogenic spread. This results in a swelling on the forehead, hence the name. The infection can also spread inwards, leading to an intracranial abscess. Pott's puffy tumor can be associated with cortical vein thrombosis, epidural abscess, subdural empyema, and brain abscess.
A pathologic fracture is a bone fracture caused by weakness of the bone structure that leads to decrease mechanical resistance to normal mechanical loads. This process is most commonly due to osteoporosis, but may also be due to other pathologies such as cancer, infection, inherited bone disorders, or a bone cyst. Only a small number of conditions are commonly responsible for pathological fractures, including osteoporosis, osteomalacia, Paget's disease, Osteitis, osteogenesis imperfecta, benign bone tumours and cysts, secondary malignant bone tumours and primary malignant bone tumours.
Toddler's fractures are bone fractures of the distal (lower) part of the shin bone (tibia) in toddlers and other young children. The fracture is found in the distal two thirds of the tibia in 95% of cases, is undisplaced and has a spiral pattern. It occurs after low-energy trauma, sometimes with a rotational component.
Xanthogranulomatous osteomyelitis is a peculiar aspect of osteomyelitis characterized by prevalent histiocytic infiltrate and foamy macrophage clustering.
Vertebral osteomyelitis is a type of osteomyelitis that affects the vertebrae. It is a rare bone infection concentrated in the vertebral column. Cases of vertebral osteomyelitis are so rare that they constitute only 2%-4% of all bone infections. The infection can be classified as acute or chronic depending on the severity of the onset of the case, where acute patients often experience better outcomes than those living with the chronic symptoms that are characteristic of the disease. Although vertebral osteomyelitis is found in patients across a wide range of ages, the infection is commonly reported in young children and older adults. Vertebral osteomyelitis often attacks two vertebrae and the corresponding intervertebral disk, causing narrowing of the disc space between the vertebrae. The prognosis for the disease is dependent on where the infection is concentrated in the spine, the time between initial onset and treatment, and what approach is used to treat the disease.
Osteomyelitis of the jaws is osteomyelitis which occurs in the bones of the jaws. Historically, osteomyelitis of the jaws was a common complication of odontogenic infection. Before the antibiotic era, it was frequently a fatal condition.
DOCK8 deficiency, also called DOCK8 immunodeficiency syndrome, is the autosomal recessive form of hyperimmunoglobulin E syndrome, a genetic disorder characterized by elevated immunoglobulin E levels, eosinophilia, and recurrent infections with staphylococcus and viruses. It is caused by a mutation in the DOCK8 gene.
Diabetic foot infection is any infection of the foot in a diabetic person. The most frequent cause of hospitalization for diabetic patients is due to foot infections. Symptoms may include pus from a wound, redness, swelling, pain, warmth, tachycardia, or tachypnea. Complications can include infection of the bone, tissue death, amputation, or sepsis. They are common and occur equally frequently in males and females. Older people are more commonly affected.
Elbow pain generally refers to discomfort in the joint (elbow) between the upper arm and forearm. Elbow pain is a common complaint in both the emergency department and in primary care offices. The CDC estimated that 1.15 million people visited an emergency room for elbow or forearm-related injuries in 2020. There are many possible causes of elbow discomfort but the most common are trauma, infection, and inflammation. Pain may be acute, chronic or associated with a number of other symptoms. Treatments range from conservative measures, such as ice and rest, to surgical interventions, depending on the underlying cause and severity.