Brodie abscess overview
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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]
Synonyms and keywords: Subacute Osteomyelitis
Overview
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.
Historical Perspectives
Brodie abscess is first described by a British surgeon, sir Benjamin Brodie, in 1832. He amputated the leg of a man who had had intractable pain 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.
Classification
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. Type IB: Metaphyseal radiolucency with surrounding reactive bone. Type II: Metaphyseal radiolucency with cortical erosion. Type III: Cortical diaphyseal radiolucency with periosteal reaction. Type IV: Diaphyseal lesion with sub periosteal new bone formation. Type V: Epiphyseal radiolucency that may appear similar to a chondroblastoma. Type VI: Vertebral lesion that may mimic eosinophilic granuloma or tuberculous spondylitis.
Pathophysiology
Local trauma and bacteremia lead to increased susceptibility to bacterial seeding of the metaphysis. history of trauma is reported in 30% of patients.