Brodie abscess of the tibia
Several months of persistent right knee pain, intermittent night sweats and elevated WCC. History of osteomyelitis.
CT right knee
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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.
The findings are consistent with a Brodie abscess.
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.
- 1. Oudjhane K, Azouz EM. Imaging of osteomyelitis in children. (2001) Radiologic clinics of North America. 39 (2): 251-66. Pubmed
- 2. Radiographic Imaging in Osteomyelitis: The Role of Plain Radiography, Computed Tomography, Ultrasonography, Magnetic Resonance Imaging, and Scintigraphy. (2009) Seminars in Plastic Surgery. 23 (02): 080. doi:10.1055/s-0029-1214160 - Pubmed