Orthopedics · Bone and Joint Infections (Osteomyelitis, Septic Arthritis)

Brodie's abscess is a clinical variant of chronic osteomyelitis. Which radiological feature is PATHOGNOMONIC of Brodie's abscess?

  • A Well-defined metaphyseal lucency with sclerotic margin, possibly with a sclerotic track to the physis
  • B Involucrum surrounding a sequestrum
  • C Laminated periosteal reaction (onion-peel appearance)
  • D Codman's triangle at the metaphysis
Correct answer: A. Well-defined metaphyseal lucency with sclerotic margin, possibly with a sclerotic track to the physis

Explanation

Brodie's abscess is a subacute/chronic low-virulence osteomyelitis (often Staph. aureus) presenting as a well-defined radiolucent cavity with a sclerotic border in the metaphysis, most commonly in the distal tibia. A key radiological feature is a 'channel sign' — a tortuous sclerotic track extending from the abscess toward the physis, representing the worm-like path of earlier spread. Involucrum and sequestrum are features of established chronic osteomyelitis. Laminated periosteal reaction is Ewing sarcoma. Codman's triangle is a periosteal reaction sign in aggressive bone tumors.

Reference: Maheshwari Essential Orthopaedics, 6th ed.

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