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Brodie’s abscess

McHugh CHM - MedPix (2006)

View Article: MedPix Image - MedPix Case

Affiliation: Uniformed Services University

ABSTRACT

Diagnosis: Brodie’s abscess

History: 14 year old boy presented initially for a sprained right ankle. No abnormalities were found at that time. The patient returned to clinic after 15 months due to increased swelling and pain in the right ankle over a 6 month period.

Findings: Figure 1: Initial anteroposterior (A-P) radiograph of the right distal tibia and fibula 15 months prior to the current presentation showed no evidence of fracture and mild soft tissue swelling around the lateral malleolus. Incidentally, a lucent lesion with a well defined cortical margin was found along the lateral distal tibia, consistent with a nonossifying fibroma. Figure 2: Follow-up A-P radiograph of the right distal tibia and fibula 15 months after the initial injury shows a bilocular lytic lesion of the metaphysis and a unilocular lytic lesion of the epiphysis at the medial aspect of the tibia. The lesions are surrounded by a well defined sclerotic border with benign-appearing periosteal reaction and mild soft tissue swelling medially. The metaphyseal lesions extend across the physis into the epiphysis. There are no fracture lucencies and the joint spaces are maintained. The nonossifying fibroma of the lateral distal tibia is unchanged. Figure 3: A Tc-99m HDP bone scan demonstrates increased radiotracer uptake at the distal tibial meta-epiphysis, most marked on the medial aspect of the epiphysis. Figure 4: Axial T1-weighted MR image of right leg reveals multiple well defined low signal intensity masses surrounded by a thick medium intensity rim with a low signal intensity periphery. The tibial metaphyseal component measures 2.1cm longitudinal x 1.6cm transverse x 2.1cm AP. The epiphyseal component measures 2 cm longitudinal x 2.3cm transverse x 3cm AP. The inflammatory process extends posteromedially through the cortex of the tibial epiphysis to involve the adjacent soft tissues. Figure 5: On axial T2-weighted fat saturated MR image of the right leg, masses become high-signal intensity surrounded by low-signal intensity rims. The high signal-intensity inflammation extends into the adjacent soft tissues. There is a low signal intensity thickening of the soft tissues medially which extends anteriorly to the anterior aspect of the anterior-tibial tendon and posteriorly to the lateral aspect of the tibial tendon, flexor digitorum longus tendon and hallucis longus tendon. There are non-enhancing foci within the soft tissue consistent with extensive inflammation. Figure 6: Axial T1-weighted MR image after contrast demonstrates well defined masses with non-enhancing centers, enhancing thick rim, and non-enhancing periphery. The non-enhancing central lesions correspond to the low signal intensity centers seen on T1-weighted MR and high signal intensity centers seen on T2-weighted MR, which together is consistent with necrosis. The epiphyseal lesion expands through the anteromedial border of the tibia with extension of the abscess into the adjacent soft tissues. High-signal-intensity bone marrow edema extends 5.5cm proximally into the distal tibial diaphysis from the site of the lesions.

Ddx: Brodie’s abscess Eosinophilic granuloma.

Dxhow: Histology and cultures grew Staphylococcus aureus

Exam: Physical exam at follow-up visit revealed swelling, erythema, and tenderness to palpation at the medial ankle.

No MeSH data available.


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Brodie’s abscess

McHugh CHM - MedPix (2006)

© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=MPX1129&req=5

View Article: MedPix Image - MedPix Case

Affiliation: Uniformed Services University

ABSTRACT

Diagnosis: Brodie’s abscess

History: 14 year old boy presented initially for a sprained right ankle. No abnormalities were found at that time. The patient returned to clinic after 15 months due to increased swelling and pain in the right ankle over a 6 month period.

Findings: Figure 1: Initial anteroposterior (A-P) radiograph of the right distal tibia and fibula 15 months prior to the current presentation showed no evidence of fracture and mild soft tissue swelling around the lateral malleolus. Incidentally, a lucent lesion with a well defined cortical margin was found along the lateral distal tibia, consistent with a nonossifying fibroma. Figure 2: Follow-up A-P radiograph of the right distal tibia and fibula 15 months after the initial injury shows a bilocular lytic lesion of the metaphysis and a unilocular lytic lesion of the epiphysis at the medial aspect of the tibia. The lesions are surrounded by a well defined sclerotic border with benign-appearing periosteal reaction and mild soft tissue swelling medially. The metaphyseal lesions extend across the physis into the epiphysis. There are no fracture lucencies and the joint spaces are maintained. The nonossifying fibroma of the lateral distal tibia is unchanged. Figure 3: A Tc-99m HDP bone scan demonstrates increased radiotracer uptake at the distal tibial meta-epiphysis, most marked on the medial aspect of the epiphysis. Figure 4: Axial T1-weighted MR image of right leg reveals multiple well defined low signal intensity masses surrounded by a thick medium intensity rim with a low signal intensity periphery. The tibial metaphyseal component measures 2.1cm longitudinal x 1.6cm transverse x 2.1cm AP. The epiphyseal component measures 2 cm longitudinal x 2.3cm transverse x 3cm AP. The inflammatory process extends posteromedially through the cortex of the tibial epiphysis to involve the adjacent soft tissues. Figure 5: On axial T2-weighted fat saturated MR image of the right leg, masses become high-signal intensity surrounded by low-signal intensity rims. The high signal-intensity inflammation extends into the adjacent soft tissues. There is a low signal intensity thickening of the soft tissues medially which extends anteriorly to the anterior aspect of the anterior-tibial tendon and posteriorly to the lateral aspect of the tibial tendon, flexor digitorum longus tendon and hallucis longus tendon. There are non-enhancing foci within the soft tissue consistent with extensive inflammation. Figure 6: Axial T1-weighted MR image after contrast demonstrates well defined masses with non-enhancing centers, enhancing thick rim, and non-enhancing periphery. The non-enhancing central lesions correspond to the low signal intensity centers seen on T1-weighted MR and high signal intensity centers seen on T2-weighted MR, which together is consistent with necrosis. The epiphyseal lesion expands through the anteromedial border of the tibia with extension of the abscess into the adjacent soft tissues. High-signal-intensity bone marrow edema extends 5.5cm proximally into the distal tibial diaphysis from the site of the lesions.

Ddx: Brodie’s abscess Eosinophilic granuloma.

Dxhow: Histology and cultures grew Staphylococcus aureus

Exam: Physical exam at follow-up visit revealed swelling, erythema, and tenderness to palpation at the medial ankle.

No MeSH data available.