Review Question - QID 217483

Appropriate management of a Brodie’s abscess includes surgical debridement followed by IV antibiotics.

Osteomyelitis in children and adolescents is most commonly the result of hematogenous seeding of the metaphyseal region of bone. The diagnosis is made with a careful history and physical and advanced imaging, as lab values may be close to normal. When an intra-osseous abscess (i.e. Brodie's abscess) is seen, surgical debridement and IV antibiotics are warranted.

Van der Naald et al performed a systematic review of published cases of Brodie’s abscesses. They found that 84% of patients were afebrile and less than 50% had elevated inflammatory markers. Staphylococcus aureus was the most common pathogen and 94% of patients required surgery.

Brailsford wrote a review of Brodie’s abscesses in 1938. He highlighted the importance of clinical history in making the diagnosis, with recurrent extremity pain, history of local infection in the area, and resistance to other therapies being common. He discussed favorable results with surgery and eventual radiographic filling of the resultant defect.

Figure A is an AP radiograph demonstrating a non-specific lytic lesion of the distal tibial metaphysis. Figure B is a coronal MRI demonstrating a Brodie’s abscess with surrounding enhancement to suggest infection.

Incorrect Answers:
Answer 1: Empiric IV antibiotics may be attempted for osteomyelitis without an abscess, but a Brodie’s abscess requires surgical debridement.
Answer 2: A CT of the chest may be warranted in the staging of bone and soft tissue malignancies.
Answer 3: A bone scan may be warranted in the staging of malignancy, such as Ewing’s sarcoma.
Answer 4: A short leg cast and close observation would be the treatment for a non-displaced or occult fracture, but not for active infection with an intra-osseous abscess.