Brodie abscess

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Brodie abscess
BrodieAbscessAxT1.jpg
Axial T1-weighted MRI image through the distal tibia showing Brodie abscess.
Specialty Orthopedic surgery   OOjs UI icon edit-ltr-progressive.svg

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.

Contents

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.

Signs and symptoms

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]

Causes

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]

Diagnosis

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]

Treatment

Surgery was the main form of treatment, frequently in conjunction with antibiotics. [1]

Outlook

The prognosis is usually favorable, with very little likelihood of a lasting disability or recurrence. [1]

Epidemiology

Brodie abscess is responsible for 2.5%–42% of primary bone infections. [3]

History

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]

See also

References

  1. 1 2 3 4 van der Naald, Niels; Smeeing, Diederik P.J.; Houwert, Roderick M.; Hietbrink, Falco; Govaert, Geertje A.M.; der, Detlef van (2019-01-24). "Brodie's Abscess: A Systematic Review of Reported Cases". Journal of Bone and Joint Infection. 4 (1). Copernicus GmbH: 33–39. doi:10.7150/jbji.31843. ISSN   2206-3552. PMC   6367194 . PMID   30755846.
  2. 1 2 Chen, Benjamin C; Kobayashi, Takaaki; O'Rourke, Howard; Sekar, Poorani (2021). "Staphylococcus aureusosteomyelitis causing Brodie's abscess of the tibia in an adult man". BMJ Case Reports. 14 (1) e240836. BMJ. doi:10.1136/bcr-2020-240836. ISSN   1757-790X. PMC   7813403 . PMID   33462070.
  3. 1 2 3 4 Qi, Ruyu; Colmegna, Inés (2016-09-19). "Brodie abscess". Canadian Medical Association Journal. 189 (3). CMA Joule Inc.: E117. doi:10.1503/cmaj.151419. ISSN   0820-3946. PMC   5250519 . PMID   27647617.
  4. ↑ Metsemakers, WJ.; Morgenstern, M.; McNally, M.A.; Moriarty, T.F.; McFadyen, I.; Scarborough, M.; Athanasou, N.A.; Ochsner, P.E.; Kuehl, R.; Raschke, M.; Borens, O.; Xie, Z.; Velkes, S.; Hungerer, S.; Kates, S.L.; Zalavras, C.; Giannoudis, P.V.; Richards, R.G.; Verhofstad, M.H.J. (2018). "Fracture-related infection: A consensus on definition from an international expert group". Injury. 49 (3). Elsevier BV: 505–510. doi:10.1016/j.injury.2017.08.040. hdl: 1765/101708 . ISSN   0020-1383. PMID   28867644.
  5. ↑ Peng, Jiachen; Ren, Youliang; He, Wenbin; Li, Zhengdao; Yang, Jin; Liu, Yi; Zheng, Zhonghui; Kates, Stephen L.; Schwarz, Edward M.; Xie, Chao; Xu, Youjia (2017-05-04). "Epidemiological, Clinical and Microbiological Characteristics of Patients with Post-Traumatic Osteomyelitis of Limb Fractures in Southwest China: A Hospital-Based Study". Journal of Bone and Joint Infection. 2 (3). Copernicus GmbH: 149–153. doi:10.7150/jbji.20002. ISSN   2206-3552. PMC   5441147 . PMID   28540152.
  6. ↑ Lew, Daniel P; Waldvogel, Francis A (2004). "Osteomyelitis". The Lancet. 364 (9431). Elsevier BV: 369–379. doi:10.1016/s0140-6736(04)16727-5. ISSN   0140-6736. PMID   15276398.
  7. ↑ Hotchen, Andrew J.; McNally, Martin A.; Sendi, Parham (2017-09-12). "The Classification of Long Bone Osteomyelitis: A Systemic Review of the Literature". Journal of Bone and Joint Infection. 2 (4). Copernicus GmbH: 167–174. doi:10.7150/jbji.21050. ISSN   2206-3552. PMC   5671929 . PMID   29119075.
  8. ↑ McHugh, C. H.; Shapeero, L. G.; Folio, L.; Murphey, M. D. (July 2007). "Case for diagnosis. Brodie abscess". Military Medicine. 172 (7): viii–xi. ISSN   0026-4075. PMID   17691698.

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