Precision of SPECT/CT Allows the Diagnosis of a Hidden Brodie’s Abscess of the Talus in a Patient with Sickle Cell Disease

Abstract

Brodie’s abscess is a rare subacute osteomyelitis that can be found in sickle cell disease along with other bone complications. A 21-year-old female with sickle cell disease was presenting frequently to the medical casualty department for painful vasoocclusive crises and for persistent ankle pain and swelling. Hybrid imaging with single-photon emission computed tomography-computed tomography (SPECT-CT) incidentally revealed Brodie’s abscess in the talus bone of the ankle, causing persisting long-standing pain. SPECT-CT is a modern technology used to scan bone to detect both anatomical and functional abnormalities with high specificity. Brodie’s abscess is a rare bone inflammation that could be a hidden cause of pain and infection in sickle cell disease. Although rare, this lesion requires more attention in patients with sickle cell disease because their immunocompromised status renders them prone to this infection.

The “Penumbra Sign” on Magnetic Resonance Images of Brodie’s Abscess: A Case Report and Literature Review

“…Whole body bone scintigraphy is also indicated if multifocal disease is suspected or is performed as part of a tumor work-up when the diagnosis is uncertain. The hybrid fused single photon emission computed tomography-computed tomography -SPECT-CT has the ability to provide both functional information and anatomic localization of the lesion and better definition of a lesion in an obscured location [9].…”

Brodie’s Abscess in a Patient Presenting with Sickle Cell Vasoocclusive Crisis

“…Magnetic resonance imaging (MRI) shows characteristic features including the pronounced rim enhancement, the “double line” sign, and the “penumbra” sign [ 5 ] and reveals the well-circumscribed nature of the lesion as compared to more extensive involvement seen in diffuse osteomyelitis [ 1 ]. SPECT-CT is a hybrid imaging technique that has also been used in the diagnosis of Brodie's abscess [ 6 ]. It integrates single-photon emission computed tomography (SPECT) and routine CT, allowing for the direct fusion of morphological and functional information.…”

Rare presentation of Brodie's abscess in the acromion process and the value of the penumbra sign

“…The patient history was suggestive of an infectious problem, which was strongly supported by a positive penumbra sign. When the diagnosis is unclear and conventional imaging techniques fail to offer a conclusive diagnosis, (hybrid) nuclear imaging techniques such as single-photon emission CT/CT, positron emission tomography/CT and technetium bone scans can be of value, especially for unconventional presentations or to identify multiple lesions 4 12 30…”

“…Men are affected 2–3 times more often 2 3 5 9. Brodie's abscesses most often occur in the tibia and distal femur,2–4 8–10 but other locations such as the talus,11 12 patella,13 proximal femur,3 14 cuboid bone,15 16 distal radius,17 fibula,9 clavicle,8 skull,2 pelvis2 and calcaneus have been described 18…”