[布罗迪脓肿,一种难以诊断的病理]。

Isadora Silva C, María Jesús Figueroa G, Ismael Cañete C, Felipe Hodgson O, Alejandro Gündel P
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引用次数: 0

摘要

儿童急性骨关节感染是一种罕见的疾病,因此早期诊断和及时治疗对于避免急性和长期并发症至关重要。Brodie's脓肿(BA)是一种少见的亚急性骨髓炎,诊断困难,临床怀疑是必要的。目的:报告1例布罗迪脓肿的病因及临床特点。临床病例:14岁患者,右大腿疼痛1个月,无发热及外伤史。体格检查显示体积未增加,右髋关节活动范围疼痛,右髂胫束浅表触诊敏感性增加。x光片正常。由于疼痛持续,要求进行超声检查,结果显示皮质不规则。磁共振成像(MRI)显示右股骨干,由于可能的骨肿瘤或感染过程。实验室检查正常收集活检和培养,确定多重敏感的金黄色葡萄球菌。患者接受清创和静脉注射抗生素治疗,反应积极。结论:BA的临床特征和实验室检查是不特异性的,因此,即使没有其他症状或炎症参数正常,非专科医生也应强烈怀疑这种病理作为持续疼痛和影像学改变的患者可能的鉴别诊断。骨活检对于肿瘤病理的鉴别诊断是必不可少的。
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[Brodie's abscess, a pathology difficult to diagnose].

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. Ob jective: 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.

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