Summary: An otherwise healthy 24-year-old Columbian woman presented to her
primary care physician with a 1-year history of progressive pain and
palpable abnormality in the proximal left tibia. On physical exam, the
anterior portion of the tibia demonstrated mild erythema, with a vague
palpable abnormality. The patient was afebrile. Laboratory results
yielded a mild leukocytosis and elevated sedimentation rate. The patient
denied any history of trauma.
Culture-negative chronic osteomyelitis of the tibia with a Brodie’s abscess
Initial radiographs demonstrated an expansile, sclerotic lesion in
the proximal diaphysis of the left tibia, with a subtle tubular focus of
lucency in the central portion of the medullary shaft (Figure 1). The
radiographic findings were considered highly suspicious for chronic
osteomyelitis with a possible intra-osseous bone abscess (Brodie’s
abscess). Magnetic resonance (MR) imaging with gadolinium was performed
for further evaluation.
The MR demonstrated patchy marrow edema
and enhancement within the proximal diaphysis of the left tibia. In
addition, in the central portion of the medullary canal, there was an
8.5 cm x 0.5 cm focus of linear signal abnormality, and enhancement,
suspicious for an intra-osseous abscess (Brodie’s abscess). There was
also mild thickening of the adjacent cortical bone (likely related to
chronic periosteal reaction), and minimal edema in the adjacent
subcutaneous soft tissues (Figures 2-4). Overall, the constellation of
findings was nearly diagnostic of chronic osteomyelitis with a Brodie’s
There are 4 routes of contamination in the development of
osteomyelitis, including hematogenous, spread from a contiguous
source, direct implantation, and post-operative.1 The most common pathogens are somewhat age dependent, but the most common is Staphylococcus aureus.
The term Brodie’s abscess was initially described by Sir Benjamin Collins Brodie in 1832.2 A
Brodie’s abscess can be seen in both the subacute and chronic stages of
osteomyelitis. These lesions, which are more commonly seen in children,
typically demonstrate an elliptical or tubular shape, and are most
commonly located near the metaphysis. A Brodie’s abscess is a cavity
containing purulent fluid or mucus, lined with granulation tissue, and
surrounded by sclerotic bone. This often produces characteristic
radiographic features, which can facilitate the diagnosis and treatment
plan. MR is also useful for accurately characterizing the size and shape
of a Brodie’s abscess,to guide therapy and to help plan for surgery.3-5 If not diagnosed properly, osteomyelitis can progress and become more difficult to eradicate.
The radiographic findings of chronic osteomyelitis with a Brodie’s
abscess are often characteristic. In the proper clinical
setting,identification of an elliptical or tubular-shaped lytic lesion,
with adjacent sclerotic changes, is highly suspicious for infection. MR
is also useful for more accurately characterizing the size and shape of a
Brodie’s abscess. Radiology can play a key role in making the diagnosis
and in determining the most effective treatment plan.
- Resnick D. Osteomyelitis. Septic arthritis, and soft tissue infection: Axial skeleton. In: Bone and Joint Imaging. 2nd ed. Philadelphia, Pa: W.B. Saunders; 1996:674-683.
- Brodie BC. An account of some cases of chronic abscess of the tibia. Med Chir Trans. London, 1832;17:239-249.
- Bohndorf K. Infection of the appendicular skeleton. Eur Radiol. 2004;14;suppl 3:E53-E63. Review.
- Gold RH, Hawkin RA, Katz RD. Bacterial osteomyelitis: Findings on plain radiography, CT, MR and scintigraphy. AJR Am J Roentgenol. 1991;157:365-370.
- Erdman WA, Tamburoo F, Jayson HT, et al. Osteomyelitis: Characteristics and pitfalls with MR imaging. Radiology. 1991;180:533-539.