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.
| Brodie abscess | |
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| Axial T1-weighted MRI image through the distal tibia showing Brodie abscess. | |
| Specialty | Orthopedic surgery  |
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
editBrodie'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
editWhen 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
editSince 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
editSurgery was the main form of treatment, frequently in conjunction with antibiotics.[1]
Outlook
editThe prognosis is usually favorable, with very little likelihood of a lasting disability or recurrence.[1]
Epidemiology
editBrodie abscess is responsible for 2.5%–42% of primary bone infections.[3]
History
editBrodie 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
editReferences
edit- ^ a b c d 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.
- ^ a b 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). BMJ: e240836. doi:10.1136/bcr-2020-240836. ISSN 1757-790X. PMC 7813403. PMID 33462070.
- ^ a b c d 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.
- ^ 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.
- ^ 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.
- ^ 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.
- ^ 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.
- ^ 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.
Further reading
edit- Foster, Catherine E.; Taylor, Margaret; Schallert, Erica K.; Rosenfeld, Scott; King, Katherine Y. (2019). "Brodie Abscess in Children: A 10-Year Single Institution Retrospective Review". Pediatric Infectious Disease Journal. 38 (2): e32–e34. doi:10.1097/INF.0000000000002062. ISSN 0891-3668. PMID 29620720.
- Salik, Muhammad; Mir, Muhammad Hussain; Philip, Deepa; Verma, Shobit (2021-07-16). "Brodie's Abscess: A Diagnostic Conundrum". Cureus. 13 (7). Springer Science and Business Media LLC: e16426. doi:10.7759/cureus.16426. ISSN 2168-8184. PMC 8369975. PMID 34422465.