Presentation
Several months of persistent right knee pain, intermittent night sweats and elevated WCC. History of osteomyelitis.
Patient Data
Unenhanced CT of the right knee demonstrates a lucent ovoid lesion centered at the proximal tibial metaphysis and extending into the epiphyseal plate. There is a narrow zone of transition with somewhat sclerotic borders and a central calcific focus. A draining tract extends anteriorly through the physis to the tibial tuberosity.
Comment:
The findings are consistent with a Brodie abscess.
Case Discussion
This is a classic example of a Brodie abscess of chronic osteomyelitis which most commonly affects the tibial metaphysis1. The medullary lesion can harbor a focus of demineralized bone (sequestrum) which may become surrounded by dense periosteal new bone (involucrum). A draining tract (cloaca) provides a means of decompressing the abscess cavity2.
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