Chronic osteomyelitis (with Brodie abscess)

Case contributed by Dr Domenico Nicoletti

Presentation

Fever, swelling and pain of the proximal tibia for about two months

Patient Data

Age: 15 years
Gender: Male

Right knee

X-ray

Lucency within the proximal tibial metaphysis, medially, with surrounding reactive sclerosis and soft tissue swelling.

Right knee

CT

Cortical lytic lesion of the anteromedial tibial metaphysis with periosteal thickening, reactive sclerosis, and new bone apposition.

Right knee

MRI

Erosion through the anteromedial tibial cortex, which extends extensively into the surrounding soft tissues where abscess extending between the muscles is located. There is also marrow edema of the tibia but not "penumbra sign" of the abscess cavity in T1-weighted images.

Histological report

Case Discussion

Brodie abscess is a form of subacute osteomyelitis manifesting as a focal lytic lesion that can contain a sequestrum and be surrounded by bone sclerosis. It usually involves long bone metaphysis. Periosteal reaction may be absent.

The "penumbra sign" is a thin layer of vascularized granulation tissue that lines the cavity of the abscess and appears slightly hyperintense in T1-weighted images with strongly and rapidly enhance after contrast.

Case courtesy :  Dr.ssa Laura Braccaioli

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