Radiological changes in the formation of Brodie's abscess by sequential magnetic resonance imaging: a case report

Abstract

Brodie's abscess is a relatively rare subacute form of osteomyelitis. Early diagnosis is challenging because of its insidious onset and vague symptoms. Magnetic resonance imaging is helpful in the diagnosis of Brodie's abscess; however, to date, no study has described the imaging findings of this disease in the early stage. Here, we present the case of a 14 year-old boy with Brodie's abscess in the proximal tibia. The lesion initially presented as a bone marrow edema in the proximal metaphysis of the left tibia on MRI and was misinterpreted as a bone bruise. Further radiological examination was performed 1 month later; this revealed the formation of an abscess cavity, which suggested Brodie's abscess. The patient was referred to our hospital and underwent curettage and debridement, which led to the definitive diagnosis of Brodie's abscess on histopathological findings and bacterial culture. On careful retrospective evaluation, the initial radiological findings suggested a microabscess on the metaphyseal side of the growth plate and bone marrow edema spreading from the lesion to the epiphysis. These radiological changes could be reliable evidence proving that the metaphyseal side of the growth plate is the origin of Brodie's abscess. Moreover, bone marrow edema with suspected microabscess in the metaphysis of the long bones can be the initial stage of the formation of Brodie's abscess and should be carefully followed up.