Pediatric Hip Pain with Bone Lesion, Sepsis, and Occam's Razor = Brodie's Abscess Case Report

Abstract

Introduction: Brodie's abscess is one type of subacute osteomyelitis that can be difficult to diagnose because characteristic signs and symptoms can be subtle and non-specific. Up to 90% of Brodie's abscess cases are initially misdiagnosed, with a mean delay of 3 months to the correct diagnosis, with 50% of them misdiagnosed as tumors. Other conditions can also present quite similarly.

Case report: A 7-year-old male presented with complaints of hip pain and inability to bear weight. X-rays revealed Brodie's abscess in the proximal femur which was initially misdiagnosed as toxic synovitis with an incidental unicameral bone cyst (UBC).

Conclusion: Brodie's abscess can be a diagnosis that is easily missed and should be included in the differential diagnosis when a child presents with a limp, inability to bear weight, or when a cortical lucency is seen on X-ray. There are no other cases in the literature of Brodie's abscess presenting like toxic synovitis. This case is relevant to pediatricians and orthopedists, particularly pediatric orthopedists.

Keywords: Brodie’s abscess; septic arthritis; toxic synovitis; unicameral bone cyst.

Figure 1

(a and b) Pre-operative AP and frog pelvis radiographs show a cystic structure without a sclerotic border at the left femoral neck

Figure 2

(a-c) 2a MRI, 2b CT (sagittal), and 2c CT (coronal) shows the lesion has a sinus tract exiting the femoral neck.

Figure 3

(a, b) Pelvis radiographs obtained 9 days postoperatively showed the lytic lesion in the left femoral neck.

Figure 4

(a, b) AP and frog view pelvis radiographs obtained 18 months postoperatively show resolved lesions.