Brodie abscess

Brodie abscess (C. C. Brodie) - clearly distinguished chronic inflammatory disease of the bone caused most often by Staphylococcus aureus.
Brodie abscess - the disease is relatively rare, and usually occurs in young men.
In typical cases abscess is localized in the cancellous periarticular Department of long tubular bones (in most cases - of the tibia) and is characterized by a very long, long course with a rarely occurring outbreaks, usually without increasing the temperature and changes in the blood picture. Sometimes abscess Brodie flows almost asymptomatic. The causative agent in the content of the abscess is often missing.
Anatomical substrate abscess Brodie is the cavity of a bone, made by granulations and liquid content: pus or serous fluid. Acute indicate the content of the abscess weakened pathogens, and the so-called dormant infection. Destructive cavity surrounded by pyogenic shell, adjacent bone substance moderately sclerotic (fibrous), and periosteum can be somewhat thickened.
Beginning of the disease is as acute and primary chronic. Clinical signs of abscess Brodie scarce. In the period of calm his current patients feel in good General condition of the local mild pain, aggravated by palpation in the area of abscess, as well as after heavy load on a limb. Sometimes in ankle or knee joints arise limited soft-tissue swelling and redness of the skin associated with the exacerbation of the process. The close location of the abscess to the joint causes the development irritative synovitis, which creates great similarity abscess Brodie with chronic articular inflammation (such as arthritis or tuberculous arthritis). Sometimes by clinical erroneously suggested neuralgia. The aggravation of violating calm during the abscess, to the formation of a fistula does not.
Of crucial importance in the diagnosis of abscess Brodie has x-ray examination. X-ray picture is characteristic: in metaphase or metaepiphysis (children only metaphase) clearly delimited in the hearth of depression correct rounded or slightly oval-shaped sizes 1-3 cm with smooth contours around the abscess bone walls (Fig. 1). Around the hearth of depression is a narrow zone of moderate osteosclerosis (see), subtly or dramatically change into environmental structure unchanged spongy bone. With long-term existence of the abscess its delimitation expressed better. Sometimes you can see a very small local thickening of the cortical layer. Characterized by the absence of sequestration. Small areas of destruction in the depth of the bones of the abscess is not called on the location of large abscess closer to the bone surface during acute observed eccentric ossification periosteal overprint in the form accompanying the cortical layer intensive strip (Fig. 2).
In the differential diagnosis must be considered primary chronic osteomyelitis, isolated syphilis gummo and extra-articular tuberculosis hearth. When banal osteomyelitis form the center of destruction wrong, the boundaries of his fuzzy, osteosclerosis and periosteal imposing more pronounced and widespread, sometimes there sequestration. For syphilis gum is typical more considerable distribution osteosclerosis. Other diseases (bone cyst, giant cell tumor etc) easily excluded radiographically. In some cases (such as for tuberculosis ostite center of destruction of a round shape) differential diagnosis is based on clinical and x-ray observations.
Treatment is usually conservative: antibiotics and anti-inflammatory radiotherapy in the exacerbation of the process. In rare cases with clinical indications (worsening) osteotomy, scraping hearth together with pyogenic shell and introduction into the operating cavity penicillin.