Brodie abscess

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Abdulkerim Yassin, M.B.B.S[2]

Synonyms and keywords: Subacute Osteomyelitis

Brodie abscess is a rare subacute or acute chronic osteomyelitis with a pus-filled cavity, vascularized wall and hard sclerotic surrounding bone. It mostly involves the metaphysis of bones (especially tibia) but it can occur at any location and in a patients of any age. It classically presents with pain with out any other systemic symptoms. Thus making an accurate and timely diagnosis is usually difficult. It is usually mistaken with bone tumor. It has insidious onset and the inflammatory markers are unremarkable. Brodie abscess may be the result of inadequate treatment for acute osteomyelitis or may occur in the setting of a more strong host resistance to infection, inoculation with less virulent organisms, prior antibiotic exposure or a combination of these factors. Brodie’s abscesses are mostly seen in children and adolescents with an average age of 19.5 years. The most commonly identified organism is staphylococcus aureus. Other pathogens such as Pseudomonas aeruginosa, Klebsiella spp., and Salmonella typhi have been reported. In about 25% of cases, no organism is identified. The patient may present with chronic pain in the affected area in the absence of trauma. Laboratory findings are mostly includes normal WBC with differential. Inflammatory markers such Erythrocyte sedimentation rate and C-reactive protein levels are may be normal or elevated in about half of the cases. Definitive diagnosis is made with radiological imaging. The mainstay of treatment is surgical debridementt combined with antibiotics.

Brodie abscess is first described by a British surgeon, sir Benjamin Brodie, in 1832. Wiles reported Brodie abscesses as a specific form of osteomyelitis in 1951. Harris and Kirkaldy-Willis (1965) were the first to describe primary subacute osteomyelitis and present a radiograph diagnosing the condition.

Brodie abscess was first classified radiologically by Kirkaldy-Willis from East-Africa. The currently utilized classification system was initially proposed by Gledhill in 1973 and then modified by Roberts et al in 1982.

Type IA: Metaphyseal radiolucency without surrounding sclerosis. It may cause confusion with Eosinophilic granuloma.
Type IB: Metaphyseal radiolucency with surrounding reactive bone.    
Type II: Metaphyseal radiolucency with cortical erosion. It resembles Osteosarcoma.  
Type III: Cortical diaphyseal radiolucency with periosteal reaction. It looks like Osteoid Osteoma. 
Type IV: Diaphyseal lesion with sub periosteal new bone formation. This type may have the appearance of “onion-skinning” and thus be confused with Ewing’s sarcoma.
Type V: Epiphyseal radiolucency that may appear similar to a chondroblastoma. IT has similar appearance with Chondroblastoma.
Type VI: Vertebral lesion that may mimic eosinophilic granuloma or tuberculous spondylitis.

Local trauma and bacteremia lead to increased susceptibility to bacterial seeding of the metaphysis. history of trauma is reported in 30% of patients. Brodie abscess arises where the bacteria and the host defenses are equally balanced.

Staphylococcus aureus is the most common pathogens identified, however it is only isolated in as few as 75% of cases.

Other diseases such as osteoid osteoma, Langerhans cell histiocytosis, chondrosarcoma, eosinophilic granuloma or tuberculosis may have similar presentation with brodie abscess and need further investigations.

Brodie’s abscesses is generally observed in patients younger than 25 years of age, mostly seen in children and adolescents with an average age of 19.5 years.

The development of brodie`s abscess could be the result of many factors such as inadequate treatment of acute osteomyelitis or antibiotic resistance.

Brodie`s abscess is a rare subacute osteomyelitis. It is usually located within the metaphysis of long bones although diaphyseal involvement is more common in adult. Tibia is the most commonly involved bone. If left untreated,, it may cause long term disability, fracture or amputation. Prognosis is excellent after effective treatment.

Brodie’s abscesses are mostly seen in children and adolescents. It has gradual onset and can be difficult to diagnose. It presents mainly with bone pain.

The main presenting physical signs are limping, swelling and erythema.

Laboratory findings such as white blood cell count and differential usually shows normal. Erythrocyte sedimentation rate and C-reactive protein levels may be normal or could be elevated.

The diagnosis is made mainly with radiological imaging.

CT-Scan reveals the same features as x-ray but additionally It enhances sinus tract and fistula to a joint or soft tissue.

Definitive diagnosis is made using MRI.

SPECT-CT is also used to diagnose brodie`s abscess.

Blood culture and histological examination of the surgical specimen help to diagnose brodie`s abscess.

The combination of surgical debridement with antibiotics are the mainstay of treatment.

Surgical debridement includes removal of all necrotic, dead bones and infected granulation tissues.

No data available for the primary prevention of brodie abscess.

No data available for the secondary prevention of brodie abscess.

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Abdulkerim Yassin, M.B.B.S[2]

Local trauma and bacteremia lead to increased susceptibility to bacterial seeding of the metaphysis. History of trauma is reported in 30% of patients.

• Local trauma and bacteremia lead to increased susceptibility to bacterial seeding of the metaphysis. History of trauma is reported in 30% of patients. Brodie abscess arises where the bacteria and the host defenses are equally balanced. Bacteria proliferate in bone and cause inflammation and necrosis. It spreads through the haversian system or medullary cavity within the shaft and to periosteum. To reduce the systemic response, the abscess is walled-off. An osseous infection can be caused by hematogenous spread of pathogens to bone or by direct inoculations by bacteria. The organisms reach the bone from a disrupted site else where in the body such as a skin pustule, furuncles, impetigo, infected blisters and burns, or secondary to an infection of another organ system (urogenital infections, enteritis, cholangitis or endocarditis. ^[1]

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: ; Abdulkerim Yassin, M.B.B.S[2]

Staphylococcus aureus is the most common pathogens identified, however it is only isolated in as few as 75% of cases.

• Staphylococcus aureus is the most common pathogens identified, however it is only isolated in as few as 75% of cases.
• In about 25% of cases, no organism is identified.
• Other pathogens like Pseudomonas aeruginosa, Klebsiella spp., and Salmonella typhi have been reported.^[1]

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: ; Abdulkerim Yassin, M.B.B.S[2]

Brodie’s abscesses is generally observed in patients younger than 25 years of age, mostly seen in children and adolescents with an average age of 19.5 years.

• It is generally observed in patients younger than 25 years of age.
• It is mostly seen in children and adolescents with an average age of 19.5 years.
• There is a slight male predominance (male to female ratio of 3:2).
• The incidence of subacute osteomyelitis is approximately 5 in 100,000 children a year in developed countries but may be higher in developing and under developed countries.^[1][2]

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Abdulkerim Yassin, M.B.B.S[2]

The development of brodie`s abscess could be the result of many factors such as inadequate treatment of acute osteomyelitis or antibiotic resistance.

The development of brodie`s abscess could be the result of many factors such as;

• Inadequate treatment of acute osteomyelitis.
• Antibiotic resistance.
• Inoculation with less virulent organisms.
• Prior antibiotic exposure or combination of the above factors.^[1]

Template:WikiDoc Sources

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Abdulkerim Yassin, M.B.B.S[2]

Brodie`s abscess is a rare subacute osteomyelitis. It is usually located within the metaphysis of long bones although diaphyseal involvement is more common in adult. Tibia is the most commonly involved bone. If left untreated,, it may cause long term disability, fracture or amputation. Prognosis is excellent after effective treatment.

• Brodie`s abscess is a rare subacute osteomyelitis.
• Located within the metaphysis of long bones although diaphyseal involvement is more common in adult.
• Tibia is the most commonly involved bone.^[1]

If left untreated,, brodie`s abscess may cause ;

• Long term disability
• Fracture
• Amputation^[2]

• Prognosis is excellent after effective treatment and low risk of recurrence.^[2]

Template:WikiDoc Sources

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Abdulkerim Yassin, M.B.B.S[2]

Local trauma and bacteremia lead to increased susceptibility to bacterial seeding of the metaphysis. History of trauma is reported in 30% of patients.

• Local trauma and bacteremia lead to increased susceptibility to bacterial seeding of the metaphysis. History of trauma is reported in 30% of patients. Brodie abscess arises where the bacteria and the host defenses are equally balanced. Bacteria proliferate in bone and cause inflammation and necrosis. It spreads through the haversian system or medullary cavity within the shaft and to periosteum. To reduce the systemic response, the abscess is walled-off. An osseous infection can be caused by hematogenous spread of pathogens to bone or by direct inoculations by bacteria. The organisms reach the bone from a disrupted site else where in the body such as a skin pustule, furuncles, impetigo, infected blisters and burns, or secondary to an infection of another organ system (urogenital infections, enteritis, cholangitis or endocarditis. ^[1]

Template:WikiDoc Sources

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: ; Abdulkerim Yassin, M.B.B.S[2]

Staphylococcus aureus is the most common pathogens identified, however it is only isolated in as few as 75% of cases.

• Staphylococcus aureus is the most common pathogens identified, however it is only isolated in as few as 75% of cases.
• In about 25% of cases, no organism is identified.
• Other pathogens like Pseudomonas aeruginosa, Klebsiella spp., and Salmonella typhi have been reported.^[1]

Template:WikiDoc Sources

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: ; Abdulkerim Yassin, M.B.B.S[2]

Brodie’s abscesses is generally observed in patients younger than 25 years of age, mostly seen in children and adolescents with an average age of 19.5 years.

• It is generally observed in patients younger than 25 years of age.
• It is mostly seen in children and adolescents with an average age of 19.5 years.
• There is a slight male predominance (male to female ratio of 3:2).
• The incidence of subacute osteomyelitis is approximately 5 in 100,000 children a year in developed countries but may be higher in developing and under developed countries.^[1][2]

Template:WikiDoc Sources

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Abdulkerim Yassin, M.B.B.S[2]

The development of brodie`s abscess could be the result of many factors such as inadequate treatment of acute osteomyelitis or antibiotic resistance.

The development of brodie`s abscess could be the result of many factors such as;

• Inadequate treatment of acute osteomyelitis.
• Antibiotic resistance.
• Inoculation with less virulent organisms.
• Prior antibiotic exposure or combination of the above factors.^[1]

Template:WikiDoc Sources

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Abdulkerim Yassin, M.B.B.S[2]

Brodie`s abscess is a rare subacute osteomyelitis. It is usually located within the metaphysis of long bones although diaphyseal involvement is more common in adult. Tibia is the most commonly involved bone. If left untreated,, it may cause long term disability, fracture or amputation. Prognosis is excellent after effective treatment.

• Brodie`s abscess is a rare subacute osteomyelitis.
• Located within the metaphysis of long bones although diaphyseal involvement is more common in adult.
• Tibia is the most commonly involved bone.^[1]

If left untreated,, brodie`s abscess may cause ;

• Long term disability
• Fracture
• Amputation^[2]

• Prognosis is excellent after effective treatment and low risk of recurrence.^[2]

Template:WikiDoc Sources

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Abdulkerim Yassin, M.B.B.S[2]

Brodie abscess is first described by a British surgeon, sir Benjamin Brodie, in 1832. Wiles reported Brodie abscesses as a specific form of osteomyelitis in 1951. Harris and Kirkaldy-Willis (1965) were the first to describe primary subacute osteomyelitis and present a radiograph diagnosing the condition.

• Brodie abscess is first described by a British surgeon, sir Benjamin Brodie, in 1832. He severed the leg of a patient who had pain which was difficult to treat for a number of years. On examination of the amputated limb, Brodie found a cavity the size of a walnut filled with dark colored pus. The bone immediately surrounding the cavity was whiter and harder than the surrounding bone. The inner surface of the cavity appeared to be vascular. Since then, low-grade pyogenic abscesses of the bone have frequently been referred to as Brodie’s abscesses (Brodie 1832).
• Wiles reported Brodie abscesses as a specific form of osteomyelitis in 1951. Harris and Kirkaldy-Willis (1965) were the first to describe primary subacute osteomyelitis and present a radiograph diagnosing the condition. ^[1]

Template:WikiDoc Sources

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Abdulkerim Yassin, M.B.B.S[2]

Local trauma and bacteremia lead to increased susceptibility to bacterial seeding of the metaphysis. History of trauma is reported in 30% of patients.

• Local trauma and bacteremia lead to increased susceptibility to bacterial seeding of the metaphysis. History of trauma is reported in 30% of patients. Brodie abscess arises where the bacteria and the host defenses are equally balanced. Bacteria proliferate in bone and cause inflammation and necrosis. It spreads through the haversian system or medullary cavity within the shaft and to periosteum. To reduce the systemic response, the abscess is walled-off. An osseous infection can be caused by hematogenous spread of pathogens to bone or by direct inoculations by bacteria. The organisms reach the bone from a disrupted site else where in the body such as a skin pustule, furuncles, impetigo, infected blisters and burns, or secondary to an infection of another organ system (urogenital infections, enteritis, cholangitis or endocarditis. ^[1]

Template:WikiDoc Sources

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: ; Abdulkerim Yassin, M.B.B.S[2]

Staphylococcus aureus is the most common pathogens identified, however it is only isolated in as few as 75% of cases.

• Staphylococcus aureus is the most common pathogens identified, however it is only isolated in as few as 75% of cases.
• In about 25% of cases, no organism is identified.
• Other pathogens like Pseudomonas aeruginosa, Klebsiella spp., and Salmonella typhi have been reported.^[1]

Template:WikiDoc Sources

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: ; Abdulkerim Yassin, M.B.B.S[2]

Other diseases such as osteoid osteoma, Langerhans cell histiocytosis, chondrosarcoma, eosinophilic granuloma or tuberculosis may have similar presentation with brodie abscess and need further investigations.

• Other diseases such as osteoid osteoma, Langerhans cell histiocytosis, chondrosarcoma, eosinophilic granuloma or tuberculosis may have similar presentation with brodie abscess and need further investigations.^[1]

Template:WikiDoc Sources

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: ; Abdulkerim Yassin, M.B.B.S[2]

Brodie’s abscesses is generally observed in patients younger than 25 years of age, mostly seen in children and adolescents with an average age of 19.5 years.

• It is generally observed in patients younger than 25 years of age.
• It is mostly seen in children and adolescents with an average age of 19.5 years.
• There is a slight male predominance (male to female ratio of 3:2).
• The incidence of subacute osteomyelitis is approximately 5 in 100,000 children a year in developed countries but may be higher in developing and under developed countries.^[1][2]

Template:WikiDoc Sources

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Abdulkerim Yassin, M.B.B.S[2]

The development of brodie`s abscess could be the result of many factors such as inadequate treatment of acute osteomyelitis or antibiotic resistance.

The development of brodie`s abscess could be the result of many factors such as;

• Inadequate treatment of acute osteomyelitis.
• Antibiotic resistance.
• Inoculation with less virulent organisms.
• Prior antibiotic exposure or combination of the above factors.^[1]

Template:WikiDoc Sources

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Abdulkerim Yassin, M.B.B.S[2]

Brodie`s abscess is a rare subacute osteomyelitis. It is usually located within the metaphysis of long bones although diaphyseal involvement is more common in adult. Tibia is the most commonly involved bone. If left untreated,, it may cause long term disability, fracture or amputation. Prognosis is excellent after effective treatment.

• Brodie`s abscess is a rare subacute osteomyelitis.
• Located within the metaphysis of long bones although diaphyseal involvement is more common in adult.
• Tibia is the most commonly involved bone.^[1]

If left untreated,, brodie`s abscess may cause ;

• Long term disability
• Fracture
• Amputation^[2]

• Prognosis is excellent after effective treatment and low risk of recurrence.^[2]

Template:WikiDoc Sources