Brodie's Abscess: A Diagnostic Conundrum

Abstract

Atraumatic limb pain in a child raises concerns in a medical setting. That is how a typical case of Brodie's abscess presents, having pain without any other symptoms of systemic illness. Assessment and investigations might also not reveal anything significant unless adequate imaging is done. Although Brodie's abscess has a very low rate of complications and morbidity/disability, it is important that such a presentation is assessed clinically with a diagnosis of Brodie's abscess in mind to ensure an uneventful and good outcome. We illustrate in this case report a similar presentation of an 11-year-old girl who had multiple visits to primary care. She was then assessed through radiological imaging. By the time of her diagnosis, her abscess had protruded through the skin. Thankfully management was done swiftly after identification and the final outcome was good with complete recovery.

Keywords: atraumatic limp; brodie's abscess; limping child; osteo-myelitis; pyogenic osteomylitis; subacute osteomyelitis.

Figure 1. Lateral radiograph showing the lesion in the distal tibia involving the epiphysis, physis, and metaphysis

Figure 2. X-ray right foot AP and lateral view done at the time of original presentation having an inadequate view for proper diagnosis as the distal tibia is not visible

Figure 3. X-ray right distal tibia and fibula AP radiograph showing lesion in the distal tibia involving the physis and metaphysis

Figure 4. Sagittal view of right lower limb MRI demonstrating an abscess in the distal tibia breaching the cortex and extending into the surrounding soft tissue

Figure 5. Another MRI image of the same abscess showing involvement of physis and extension into the metaphysis

Figure 6. Pre-operative image showing extravasation of the abscess from the skin

Figure 7. Extravasated Brodie's abscess measuring 1.5cm in diameter

Figure 8. Intra-operative image pre-curettage of Brodie's abscess

Figure 9. Intra-operative image post-curettage. Holes were drilled to encourage blood supply and antibiotics were sprinkled in the operative site

Figure 10. Post-operative X-ray showing good healing at the former site of Brodie's abscess