Brodie's Abscess: A Diagnostic Conundrum

Abstract

Atraumatic limb pain in a child raises concerns in a medical setting. That is how a typical case of Brodie's abscess presents, having pain without any other symptoms of systemic illness. Assessment and investigations might also not reveal anything significant unless adequate imaging is done. Although Brodie's abscess has a very low rate of complications and morbidity/disability, it is important that such a presentation is assessed clinically with a diagnosis of Brodie's abscess in mind to ensure an uneventful and good outcome. We illustrate in this case report a similar presentation of an 11-year-old girl who had multiple visits to primary care. She was then assessed through radiological imaging. By the time of her diagnosis, her abscess had protruded through the skin. Thankfully management was done swiftly after identification and the final outcome was good with complete recovery.

A rare diagnosis has no certainty, but still they occur: A case report

“…MRI is the gold standard in diagnosis. MRI finding that supports the diagnosis of subacute osteomyelitis and helps to exclude the presence of a tumor is the penumbra sign [10]. The penumbra sign is characteristically seen on T1-weighted MRI (2-to 5-mm thickness).…”

“…The various differential diagnoses of Brodie's abscess are eosinophilic granuloma, osteogenic sarcoma, osteoid osteoma, osteoblastoma, enchondroma, non-ossifying fibroma, chondrosarcoma, intraosseous lipoma, ewing sarcoma, and Langerhans cell histiocytosis [10,11].…”

Brodie abscess in an 87-year-old man

“…However, the treatment should be initiated as soon as possible when a chronic abscess is suspected, as case reports also reveal that delay of treatment can slowly exacerbate the abscess, eventually leading to a sinus tract, a fi stula connecting skin and soft tissue, or bone fracture. 3,9,11 Brodie abscess is rare in older adults. However, timely diagnosis and treatment can prevent exacerbation of the abscess and avoid the need for additional surgical treatment such as bone grafting or amputation, thus shortening the duration of hospitalization and preventing long-term complications.…”

Post-traumatic Brodie’s Abscess of the Tarsal Cuboid: A Case Report and Review of the Literature

“…Brodie's abscess is a rare form of chronic pyogenic sub-acute osteomyelitis of the bones, with an insidious onset usually and without obvious clinical symptomatology, which was first described by Sir Benjamin Brodie in 1832 [1][2][3][4][5][6][7][8][9][10]. Most of the cases involve the metaphysis, epiphysis, or diaphysis of the long bones of the lower limb such as the femur or the tibia [1,2,4,7]. However, Brodie's abscess can be detected in other anatomical areas as well, including small bones such as those of the tarsus.…”