Absceso de Brodie en la clavícula: una forma poco frecuente de presentación / Brodie abscess in the clavicle: an uncommon presentation

La osteomielitis (OM) se define como la inflamación ósea de origen infeccioso. La forma aguda es frecuente en la edad pediátrica. El absceso de Brodie es un tipo de osteomielitis subaguda, históricamente con baja incidencia, pero que actualmente se presenta un aumento de la misma. De poca repercusión clínica, con pruebas de laboratorio inespecíficas y estudios radiológicos de difícil interpretación, es crucial la sospecha diagnóstica. Se asemeja a procesos neoplásicos, benignos o malignos. Recae en la experiencia del profesional realizar el diagnóstico adecuado. El tratamiento consiste en antibioticoterapia, tanto parenteral como por vía oral, y eventualmente drenaje quirúrgico. Presentamos una paciente sana que consultó por una tumoración en topografía de clavícula izquierda de 3 meses de evolución. Se realizó diagnóstico de absceso de Brodie, inició tratamiento y se obtuvo una buena respuesta. Resulta imprescindible tener un alto índice de sospecha de esta entidad para no someter al paciente a estudios, pruebas invasivas o tratamientos erróneos, y evitar secuelas a futuro.

Osteomyelitis is defined as an inflammation of the bone caused by infection. Acute osteomyelitis is common in pediatrics. A Brodie abscess is a type of subacute osteomyelitis, with a historically low incidence; however, its incidence is currently increasing. Given its little clinical impact, with non-specific laboratory tests and radiological studies of difficult interpretation, diagnostic suspicion is crucial. It resembles neoplasms, either benign or malignant. An adequate diagnosis falls on the health care provider's experience. Treatment consists of antibiotics, both parenteral and oral, with potential surgical drainage. Here we describe the case of a healthy female patient with a tumor found in the topography of the left clavicle 3 months before. She was diagnosed with Brodie abscess; treatment was started with a good response. A high index of suspicion of Brodie abscess is critical to avoid invasive tests and studies or inadequate treatments, and to prevent future sequelae.

A rare diagnosis has no certainty, but still they occur: A case report

Pain and swelling are among the most frequently encountered complaints in an orthopedics outpatient department (OPD) relatively less common in a pediatric OPD. A high level of suspicion is required to diagnose bone diseases. Common conditions such as rickets, septic arthritis, and tuberculosis must be ruled out. Treatment such as antibiotics, anti-inflammatory drugs, or steroids may mask an underlying serious condition in which if left untreated can cause significant morbidity and mortality to the person. Here, we discuss a case of a young infant 11 months of age who had symptoms suggestive of septic arthritis and was later found to have Brodie’s abscess which is a type of subacute osteomyelitis on further evaluation which is usually mistaken as a tumor. This age at presentation is rare.

Absceso de Brodie, una patología de difícil diagnóstico / Brodie's abscess, a pathology difficult to diagnose

INTRODUCCIÓN: Las infecciones osteoarticulares agudas pediátricas constituyen patologías poco frecuentes, siendo de suma importancia realizar un diagnóstico precoz y tratamiento adecuado para evitar las compli caciones agudas o a largo plazo. El absceso de Brodie (AB) es una forma de osteomielitis subaguda de baja incidencia y de difícil diagnóstico, por lo que es imprescindible la sospecha clínica. OBJETIVO: Presentar un caso de AB y describir las características etiológicas y clínicas de esta patología. CASO CLÍNICO: Paciente 14 años, evaluado por dolor de muslo derecho de un mes de evolución, afebril y sin antecedente de trauma. Al examen físico no presentaba aumento de volumen, el rango de movimiento (ROM) de cadera derecha era doloroso y la sensibilidad estaba aumentada a la palpación su perficial de banda iliotibial (BIT) derecha. Estudio radiológico sin alteraciones. Por persistir síntomas se solicitó ecografía de muslo que mostró irregularidad ósea cortical. Resonancia Magnética (RM) evidenció lesión en diáfisis de fémur derecho de probable origen tumoral o infeccioso. Parámetros inflamatorios sin alteraciones. Se realizó toma de biopsia y cultivos, aislando Staphylococcus aureus multisensible. Se procedió a aseo quirúrgico y terapia antibiótica endovenosa, evolucionando favo rablemente. CONCLUSIONES: La presentación clínica y laboratorio en AB pueden ser inespecíficas. El clínico no especialista debe tener un alto índice de sospecha de esta patología como posible diagnós tico diferencial en pacientes que persisten con dolor y presentan una alteración radiológica, incluso ante la ausencia de otros síntomas y parámetros inflamatorios normales. Es importante realizar una biopsia ósea para el diagnóstico diferencial de patologías tumorales.

INTRODUCTION: Acute osteoarticular infections in children are rare pathologies, therefore early diagnosis and prompt treatment are crucial to avoid acute and long-term complications. Brodie's abscess (BA) is an un common type of subacute osteomyelitis, difficult to diagnose, so clinical suspicion is essential. OBJECTIVE: To describe a case of Brodie's abscess and its etiological and clinical features. CLINICAL CASE: A 14-year-old patient was seen at our clinic, who reported a one-month pain in the right thigh, with no history of fever or trauma. Physical examination revealed no volume increase, painful right hip range of motion, and increased sensitivity on superficial palpation of the right iliotibial band. X-rays where normal. Because of the pain persistence, an ultrasound was requested which showed a cortical irregularity. Magnetic resonance imaging (MRI) was performed and revealed a right femoral diaphysis, due to a possible bone tumor or an infectious process. Lab tests were normal. Biopsy and cultures were collected, identifying multi-sensitive Staphylococcus aureus. He was managed with debridement and intravenous antibiotics, responding positively. CONCLUSIONS: The BA's clinical features and lab tests are unspecific, therefore the non-specialist physician should strongly suspect this pathology as a possible differential diagnosis in patients who persist with pain and present imaging alterations, even when there are no other symptoms or normal inflammatory parameters. A bone biopsy is essential for the differential diagnosis of tumor pathologies.

Brodie’s Abscess of Posterior Ilium with Gluteal Syndrome, an Unusual Cause of Paediatric Low Back Pain: A Case Report

Brodie’s abscess is a variety of subacute osteomyelitis with a long duration of presentation and intermittent pain. It usually involves the metaphyseal region of long bones of the lower limbs. Brodie’s abscess of pelvic bone is very rare. Involvement of posterior ilium with gluteal syndrome is extremely unusual and can be easily missed or misdiagnosed. We present a 9-year old boy who reported to us with intermittent low back pain of three months duration without any other constitutional symptoms. Clinically, there was mild tenderness over the posterior ilium. Computed tomography showed a lytic lesion in the posterior ilium with a breach in the outer cortex. MRI and bone scan were suggestive of inflammatory pathology. Keeping infective, tubercular and benign bone tumors as differential diagnoses, open biopsy and curettage were done. Staphylococcus aureus was cultured and histopathology was suggestive of osteomyelitis. The patient received appropriate antibiotics for six weeks. He was asymptomatic till 18 months of follow up without any recurrence. We present this case because of its rarity and unusual presentation as gluteal syndrome and low back pain, and its resemblance to other pelvic and sacroiliac joint pathologies which are often missed or misdiagnosed in paediatric patients.

Transverse Discrepancy in Orthodontics: A Review.

In today’s orthodontic practice esthetics is a primary concern both for patient and the orthodontist. The perception of esthetics for a lay person largely depends on the symmetry of the face. Hence, diagnosis and correction of the transverse discrepancy are imperative for optimum result. Some occlusal relations can result from skeletal jaw relation or from tooth positions. Malocclusion can occur in three planes of space, i.e., sagittal, transverse, and vertical plane. Transverse discrepancy is “An abnormality of development in transverse plane.” In orthodontic diagnosis and treatment planning, the emphasis is placed on recognizing asymmetry and achieving symmetric results with dental midlines coincident with each other and with the facial midline. Humans, like most other animals, are considered to display bilateral symmetry. By strict definition, this implies that mirror-image mathematical identity exists between right and left halves. In orthodontic diagnosis and treatment planning, emphasis is placed on recognizing asymmetry and achieving symmetric results. Treatment of an asymmetry can be challenging. The 1st treatment step is to diagnose if the asymmetry is of functional, dental or skeletal cause. The treatment options for transverse problem may include arch coordination, asymmetric extraction, asymmetric mechanics, and skeletal correction by orthopedic or surgical procedure. However, it is crucial to determine that the observed asymmetry is genuine and not the product of a functional or habitual shift of the mandible as is often the case with unilateral cross-bites due to reduced width of the maxillary arch.

Ossified Brodie's Ligament.

The transverse humeral ligament (THL) or Brodie’s ligament is a narrow sheet of connective tissue fibers that runs between the lesser and the greater tubercles of the humerus. Togetherwith the intertubercular groove of the humerus, the ligament creates a canal throughwhich the long head of the biceps tendon and its synovial sheath passes. The ossification of transverse humeral ligament is a rare interesting anatomical variation, which has been identified as one of the predisposing factor for biceps tendonitis and tenosynovitis. In the present study of 100 humerus bones, we found a right side humerus with completely ossified transverse humeral ligament which extended from the lateral margin of lesser tubercle to the medial margin of greater tubercle of the humerus. The Length and breadth of the ossified ligament were 8 mm and 6 mm respectively. Such an ossified ligament may damage the biceps tendon and its synovial sheath during biomechanical movement of the arm leading to anterior shoulder pain. Itmay also complicate the use of bicipital groove as a landmark for orientation of the humeral prosthesis in complex proximal humeral fractures. Hence, the anatomical knowledge of ossified transverse humeral ligament is important for the radiologist and orthopedic surgeon in diagnosis and planning the treatment for patient with anterior shoulder pain.

Radiofrequency ablation of a misdiagnosed Brodie’s abscess

Radiofrequency ablation (RFA) therapy is recognised as a safe and effective treatment option for osteoid osteoma. This case report describes a 27-year-old man who underwent computed tomography (CT)-guided percutaneous RFA for a femoral osteoid osteoma, which was diagnosed based on his clinical presentation and CT findings. The patient developed worsening symptoms complicated by osteomyelitis after the procedure. His clinical progression and subsequent MRI findings had led to a revised diagnosis of a Brodie’s abscess, which was further supported by the eventual resolution of his symptoms following a combination of antibiotics treatment and surgical irrigations. This case report illustrates the unusual MRI features of osteomyelitis mimicking soft tissue tumours following RFA of a misdiagnosed Brodie’s abscess and highlights the importance of a confirmatory histopathological diagnosis for an osteoid osteoma prior to treatment.

Brodie's Abscess Caused by Salmonella enteritica serovar Senftenberg in a Healthy Child / 대한임상미생물학회지

Salmonella enteritica serovar Senftenberg is a rare pathogen in osteomyelitis, and is not usually encountered in healthy individuals. Here we report radiological and microbiological findings of a case of Brodie's abscess caused by S. enteritica serovar Senftenberg in the left tibia of an otherwise healthy child.

Bilateral Brodie's Abcess on the Proximal Tibia / 대한정형외과학회잡지

Brodie's abcess, a local form of subacute osteomyelitis, is a rare disease and usually occurs in the metaphysis or epiphysis of the long tubular bone in young adults. Generalized symptoms and signs resembling infectious disease are uncommon. Abnomalities in laboratory findings are not severe. Because of these characteristics and nonspecific radiology, there are difficulties in the differential diagnosis with other infectious disease and tumorous conditions. The authors experienced a case of Brodie's abcess in the proximal tibia bilaterally.

Subacute Osteomyelitis of Distal Tibia Traversing the Physis in a Child: A Case Report / 대한정형외과학회잡지

A Brodie's abscess is a localized form of subacute or chronic osteomyelitis that occurs most often in the long bones of the lower extremities of young adults. Before physeal closure, it most commonly occurs in the metaphysis. In adults, the metaphyseal-epiphyseal area is involved. Rarely Brodie's abscess traverses the open growth plate, affecting the epiphysis, although such extension does not commonly result in growth disturbance. We reported a subacute osteomyelitis that traversed the physis of the distal tibia in a child, which was treated by surgical curettage and intravenous antibiotics.

Brodie's Abscess: A Case Report / 대한정형외과학회잡지

Brodie's abscess is a primary subacute pyogenic osteomyelitis that has a thin wall of fibrous tissue and sclerotic bone. The authors have encountered a case of a Brodie's abscess that was developed in the same place of both tibia at the same time and treated the case with surgery and continuous closed irrigation.