Case of the Month – June 2018

By Dr Tyson Reeve

Patient history

10 year old female, presented with a painful/ swollen left foot and ankle for 4 weeks.

The initial x-ray showed subtle lucency in the tibia and a MRI was suggested and later performed. Blood results showed elevated ESR and CRP (non-specific inflammatory markers).

Imaging and Findings

Lesion 1

16.5 x 10 x 11mm (transverse x AP x CC) T2 bright, T1 dark lesion in the anterior distal tibial metaphysis adjacent to the growth plate, with surrounding bone oedema. There is demineralisation of the anterior cortex of the tibia and these findings are consistent with a Brodie’s abscess in the setting of osteomyelitis.

Lesion 2

There is another abnormality in the distal fibula where there is a 10 x 11x 22mm circumscribed T2 bright, T1 dark lesion predominantly centered in the distal fibula metaphysis but crosses the growth plate into the epiphysis. This is also consistent with a Brodie’s abscess. There is erosion through the anterolateral cortex of the distal fibula and there is extensive surrounding T2 FS hyperintense soft tissue signal in the lateral ankle and also extending into the distal syndesmosis.

Management

Usually long term oral or IV antibiotics. Surgery to drain collections can be performed but usually as a last resort, due to potential complications.

COM Jun2018