Brodie abscess (B. S. Brodie, 1783-1862, English. Surgeon) is one of the forms of hematogenous osteomyelitis with the localization of a limited focus of inflammation in the epimethafizar sections of long tubular bones. For the first time, Brodi was described in 1830. The disease occurs in adolescent and youthful age, more often in male people. The pathogens are various strains of staphylococci. Foci is always solitary. The magnitude and form of them depend on the duration of the disease. IN early stages They are oblong or a drop-shaped form, the magnitude of them. Average 1.5-2 cm. long timing Diseases they have a spherical shape and reach 4-5 cm in diameter. The focus is always surrounded by a pronounced osteosclerosis zone (see). The periosteum above the center is thickened, hyperemic (see periostitis). The cavity is lined with a pyrogen shell, the contents of the abscess is the granulation tissue of varying degrees of maturity, pump or serous fluid.
For the disease, it is characterized by a hron, the flow after an acute principle with an increase in temperature to 39-40 ° for 2-3 days. At the same time or after 7-10 days, local pain appears near the joint nature, increasing during exercise, and later at night. There is a small swelling of soft tissues above the lesion focus, the local temperature rise, the vascular network is more clearly expressed. Exceitations are possible, which flow without increasing body temperature and are manifested by pain. Swiss is never formed. Because of the proximity of the hearth to the joint, articular phenomena can be performed in the picture of the disease to the fore. Because B. a. benign. Diagnosis It is installed only after X-ray study.
On radiographs B. a. It is represented in the form of an isolated round or oval cavity in the sponge of the bone methaphiz or metaepiff (Fig., 1 and 2) with a diameter of 2-3 cm. It is usually located superficially under the cortex bone layer. It is striking most often than the Target, less and the poor and significantly less often shoulder, radiant, elbow and other long tubular bones. The greatest size of the cavity coincides with the long bone. In the cavity, as a rule, sequesters are not detected, the inner contours of it are smooth, a narrow strip of the sclerosic spongy is evaporated around it, K-paradium gradually goes into normal bone tissue.
With small dimensions of the abscess periosal reaction, it is usually not observed. As the cavity increases and the exacerbation of the inflammatory process develops a limited precisfactory periostitis. As a result, cylindrical or spindle-shaped bone thickening occurs at the level of the cavity.
B. a. necessary differentiate with chronic osteomyelitis, metatymph and luethic process, tuberculous bone lesion, bone cyst. For chronic osteomyelitis, several foci of destruction with sequesters and periostal layers are characteristic. Metatymnial abscess is more often located intraporically and contains a sequestration. Syphilitic gumms are usually multiple, located at the bone surface and cause a distinct periosal reaction. The tuberculous focus does not have such a regular round shape and clear contours, as an abscess, and is localized mainly in epiphyshes. The bone cyst is a cavity, often with a plurality of cells, leads to a sharp thinning of the cortical layer and blistering. In some cases, B. a. have to differentiate with such pathological processesAs osteoid osteoma, eosinophilic granuloma, solitarian form of fibrous osteodysplasia, aseptic necrosis of epiphyse.
Treatment In the early stages, conservative: immobilization of gypsum Longeta by 3-4 weeks, intramuscular administration Antibiotics, taking into account the sensitivity of the bacterial flora, UHF therapy. If the conservative treatment is unsuccessful, the operation is shown - removal of abscess within healthy tissues. The outcome of the operation is always favorable.
Bibliography: Volkov M.V. Bone disease in children, M., 1974; Kryuk A. S., Grigoriev L. Ya. And Kostyk V. P. Clinic and the treatment of intracepostic abscesses of hematogenic origin, healthcare. Belforussia, No. 3, p. 64, 1967; Rainberg S. A. X-ray diagnostics of bones and joint diseases, t. 1, p. 317, M., 1964; P U B A W E V A A. E. Private X-ray diagnosis of diseases of bones and joints, p. 32, Kiev, 1967; Shevchenko V. A. X-ray pattern of hematogenic osteomyelitis with the defeat of epiphysis and metaphysis in children, orthop, and trauma., № 9, p. 13, 1969, bibliogr.; In G O D I E V. G. On Trephining The Tibia, Lond. Med. Gaz., V. 2, p. 70, 1928; Cane P. a. SGOBBIS. Le Pulizia Chirrgica Associata Al Borraggio Nel Trattamento Dell 'Abscesso Di Brodie, Minerva Ortop., V. 14, p. 116, 1963, Bibliogr.
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A abscess localized abscesses are also localized abscesses. for the most part Without a fistula or sequestration, which are one of the varieties of sluggish current chronic osteomyelitis.
For the first time, I pointed out the presence of bone abscess David in 1764, in 1764, described in detail this form in 1832. Brodie, discovered the cavity in the tibia of the tibia, amputized at the request of the patient due to unbearable sickness, not visited conservative treatment. He then led 9 such cases by highlighting them from the general group of white tumor, and in 8 other cases he treated patients by trepanication of the bone and scraping of the cavity. Since then, these observations have become more likely to publish in the literature, and this form has been named Brody's abscess. In 1901, Gross (Gross) was able to assemble 141 observations, Thomson (Thomson) in 1904 - 161, and M. F. Koretsky in 1928.-174 observations of 56 authors.
In the future, the number of observations increased even more - in 1938, Venkre and Henby (Wenger and Henby) have already found 374 cases in the literature (cyt. In A. Mezentsov). In fact, the number of these observations is much larger. In the domestic literature, more than 100 observations are described (S. A. Rainberg, F. F. Berezkin, A. Mezentesev, I. B. Kuznetsov, F. M. Danovich, I. F. Ivanitsky, M. A. Kunin, M. D. Mikhelman, etc.). In addition, M. M. Dieterihs (1932) mentions 54 cases of bone abscesses observed in the resort of Moinaki.
Most often, intraoscience abscess is clinically manifested in more mature age; average age These patients are 20-30 years old. In children, this form was almost not described and, apparently, is a big rarity. It should be assumed that the known part of such cases in children is passed and is detected by clinically only in more mature age.
But currently, the abscess of Brode is developing as a result of blockage by bacterial emboloca of one of end branches The intraskoye arterial system, as a result, develops necrosis of bones in a limited area. According to S. M. Derizhanova, generally denied the value of the embolism of vessels in the pathogenesis of osteomyelitis, the blockage of the metaphizar arteries in the origin of Brody's abscesses does not play roles.
A number of authors attaches great importance The weak virulence of infection, as a result of which the slow development of the inflammatory process occurs on a small, limited area. However, the view of the bone abscess as a qualitatively less intensive infection causes objections, since the bacteria obtained from the abscess is quite vigilant and do not differ in their own vital activity from context pathogens osteomyelitis. Pump can maintain its virulence for a long time; Even with a long-term existence of closed bone cavities, it is usually possible to highlight from their contents. golden Staphilococcus. Undoubtedly, the special reactivity of the body plays a big role, its defensive reactionAs a result, it develops as an abortive phlegmon bone marrow.
In typical cases, the causative agent is mostly staphylococcus. It is necessary, however, to indicate that the significant number of the brody abscesses described in the literature, especially in adults, refers to typhoid osteomyelitis.
V. D. Chaklin out of 17 cases in 6, patients were found in the 2-abdominal typhoid, in 4 staphylococcus.
The clinical picture in the Abscess Brody is different. It is usually observed limited sensitivity to pressure. Often, the centers do not manifest themselves and the pain occur only at times, more often at night, after physical stresses or when changing the weather. Increases temperature, chills and other symptoms of general infection are usually absent. However, there are, however, forms with periodic exacerbations, with an increase in temperature, redness of the skin, soreness at pressure and spontaneous. The process can last for years, giving remission times. S. A. Rainberg observed a disease that lasted 55 years.
Inspection usually gives little; In more pronounced cases, they find thickening in the field of metaphysis, often exist and jet phenomena In the joint. On the x-raysIn some cases, this disease is first detected in some cases, it can be seen in the spongy part of the metaphy of the cavity with a diameter of 2-2.5 cm, round or oval shape, slightly elongated from the length of the bone, with sharply defined correct circuits. As the bone grows, the cavity can move towards the diaphysia. It is surrounded by a well-pronounced sclerosis zone in the form of a narrow or wider whitish border; The surface of the bone is often visible tender periosal overlay. When the abscess localization in the diaphysia, the periosal reaction is more pronounced (Fig. 51). The operation find the cavity surrounded by a sclerosated bone and lined with a shell resembling granulation tissue or consisting of a more dense connective tissue. This cavity is made purulent, serous or blood fluid, sometimes deriters are found in it.
Many modern authors refer to Brody's abscesses and such cases in which intertensive purulent clusters and fistulas were formed. O. Starovatenko, A. I. Ellyashev, etc. Describe under this name and bone cavities with sequesters, and pathological fractures. All this significantly distinguishes many cases currently cited from that description, which originally gave Brodi. And indeed, the course of this form of osteomyelitis can be diverse.
F. F. Berezkin distinguishes three forms of Brood abscesses: 1) hidden, or squeezed, 2) mature, sluggishly current, 3) staging of exacerbation with the formation of fistula. V. D. Chaklin distinguishes: 1) a hidden period of uncertain stupid pain, 2) the period of infiltration or starting sclerosis, 3) period of abscess, 4) period of fistula.
Fig. 51. Abscess in the lower metaphy of the tibial bone (child, Ch., 7 years old). A large focus of increasing the round shape surrounded by the sclerosis zone.
The top department of the Tibial bone is most affected, followed by the distal thigh, shoulder, forearm, other bones. Separate authors belong to Brody's abscesses and bone cavities located in the epiphysees, as well as in short and flat bones (M. A. Kinn, A. I. Mariupolsky, M. M. Kazakov, S. A. Pokrovsky et al.).
Loosity of the phalange of the fingers, sternum, bones of the skull are also given.
Of the cases that we observe in 9, there was a typical described brood flow with a gradual swelling of the limb and intermittent pain.
On X-rays, the characteristic cavity was determined with the formation of a sequestrator or without that.
In addition to these typical cases, we observed another 13 patients with a process, very reminiscent of Brode abscesses, but characterized by a more acute course, with frequent exacerbations, with the formation of sequesters and fistula. The development of the disease resembled the usual form of osteomyelitis; The process was localized in metaphisis or nearby diaphysis department, however, with the formation of a fistula. It should be noted that in our observations, exacerbations were more common than described in adults. This is undoubtedly due to anatomy biological characteristics. children's age. We give one observation.
Fig. 52. Intraight abscess in the distal metaphy of tibia (child K., 7 years).
And - before the operation. Bone cavity with a sequestre and fistula;
B - six months after the operation. The cavity is made new formed
bone.
K., 7 years old. Received 19/1 1959. Regarding the unclosed fistula in the lower third of the left leg. A year ago, the boy fell from a bike.
Soon the temperature rose, swelling appeared, soreness, then fistula on the shin. There was an outpatient. Upon admission to the X-ray in the lower metaphy of the tibia, the cavity of the elongated-oval form is determined, opening towards the epiphyseal cartilage; It determines the sequestration (Fig. 52, a). The operation removed the sequestration of 2x1.5 cm in size, the cavity is dismantled and bold with penicillin and streptomycin. The wound is sewn tightly. Resistant recovery. On the X-ray after 6 months, the bone defect is filling with a new bone (Fig. 52, b).
We observed 3 cases of fracture on site of inflammatory bone cysts. Cases of the pathological fracture in the abscess Brody are found in the literature in the form of separate casual descriptions.
We give one observation.
S., 5 years. Yesterday fell on the smooth floor and received a fracture of the left hip; Before that, I did not hurt anything and did not complain about the pain. The overall condition is good, the left thigh in the bottom third is thickened. Capital and soreness are determined by feeling, there are also swelling and contractures in knee joint. On X-rays in the distal metaphy of the left hips, an oval form cavity is visible, surrounded by a somewhat sclerosic bone; In this place there is a fracture with a displacement (Fig. 53). There is a gypsum bandage with a pelvic belt. Disposable in a gypsum bandage. Was inspected in 2 years. Walks freely. Deformation and shortening of the finiteness Pet. On the X-ray in the place of the former cyst there is only incorrect form compacted area.
Fig. 53. Fracture of the hip on the site of an intraoscience abscess (child S., 5 years old).
The diagnosis is easy, if you remember this disease and make a timely x-ray.
S. A. Rainberg leads the case when the diagnosis was made 34 years after the start of the disease, as soon as X-ray was produced. However, the differential diagnosis of Abscess Brodi represents in some cases known difficulties. First of all, it can be mixed with tuberculosis, which, especially in young children, can be localized in the diaphysis of long tubular bones; Sometimes it is sometimes distinguished by an abscess also from kyot of non-inflammatory origin, in rare cases - from osteosarcoma.
With difficulty diagnosis, it is better to decide on an operation, which is shown at intra-like abscess and is to open the cavity, the removal of the content, scraping, followed by antibiotic antibiotics and the wound sewing tightly.
The above forms: 1) of the sclerosing osteomyelitis, 2) albumin, 3) intraosseous abscess - it is customary to combine into a general group of primary chronic osteomyelitis.
As can be seen from the description clinical flow These forms, such a definition is incorrect, since the beginning and with these atypical forms is often sharp or subacute, the sharp start can be viewed. To primary chronic forms Separate authors are mistakenly attributed to osteomyelitis of other etiology. It is often not taken into account that in children the reactivity of the body is livingfully; The disease takes an acute or subacute course from the very beginning, exacerbations are often observed.
Broodie Abscess (B. C. Brodie) - Clearly delimited inflammatory chronic illness The bones caused most often with golden staphylococcus.
Brodie Abscess is a relatively rare disease, usually occurs in young men.
In typical cases, the abscess is localized in the spongy substance of the near-cutting department of a long tubular bone (in the overwhelming majority of cases - tibia) and is characterized by a very long, many years of course with rare exacerbations, usually without increasing the temperature and change of blood pattern. Sometimes Brode abscesses proceeds almost asymptomatic. The pathogen in the contents of the abscess can not be absent.
The anatomical substrate of the brody abscess is the bone cavity, made by granulations and liquid content: in gear or serous fluid. The exacerbations indicate the presence in the contents of the abscess of weakened pathogens, as well as the so-called dormant infection. The destructive cavity is surrounded by a pyrogen shell, the neighboring bone substance is moderately scruised, and the periosteum can be somewhat thickened.
The beginning of the disease is both sharp and primary-chronic. Clinical signs Absésa Brodie is scuntful. During the period of calm flow, patients are tested with a good general state local nonstinned pains, increasing during palpation in the region of abscess, as well as after increased load to the limb. Sometimes in the area of \u200b\u200bankle or knee joints there are limited swelling of soft tissues and redness of the skin associated with the exacerbation of the process. The close arrangement of the abscess to the joint causes the development of irritative synovitis, which creates a large similarity of the Absés Brode with chronic articular inflammatory process (for example, rheumatic or tuberculosis arthritis). Sometimes clinical picture Errorery assumed neuralgia. The aggravation that disturbs the calm flow of abscess, does not lead to the formation of a fistula.
Crucial importance in the diagnosis of Brood abscesses has x-ray study. The radiological picture is characteristic: in metaphyism or methaepyphyphyphyism (in children only in metaphiste), a clearly deliberate focus of pouring the correct round or slightly oval shape with dimensions of 1-3 cm with smooth contours of the ambient abscesses of bone walls (Fig. 1). Around the focus of the vacuum - the unintent zone of moderate osteosclerosis (see), imperceptibly or sharply turning into the structure of the surrounding unchanged spongy bone. With a long existence of an abscess, its deliberation is expressed better. Sometimes a very small local thickening of the cortical layer is seen. Characterized by the absence of a sequestration. Small degradation foci in the depth of the periostite bone does not cause, by the location of a large abscess closer to the bone surface during the exacerbation, eccentric spelled periosal overlays are observed in the form of a concomitant cortical layer of intensive strips (Fig. 2).
IN differential diagnosis It is necessary to take into account primary-chronic osteomyelitis, an isolated syphilitic gum and an embracing tuberculous focus. With a banal osteomyelitis, the shape of the degradation focus is incorrect, its borders are fuzzy, osteosclerosis and periosal overlays are more pronounced and common, sometimes there is a sequest. The syphilitic gum is characterized by a more significant distribution of osteosclerosis. Other diseases (bone cyst, giant tumor, etc.) are easily excluded x-ray. In some cases (for example, with tuberculous acceite, the focus of destruction is also a round form) the differential diagnosis is made on the basis of clinical and radiological observation.
Treatment is usually conservative: antibiotics and anti-inflammatory radiotherapy when aggravating the process. In rare cases, with clinical indications (exacerbation) - osteotomy, the scraping of the focus together with the pyrogen sheath and the introduction into the operational cavity of Penicillin.
Abscess Brodie is quite rare, it has, however, is considerable practical importance. Acquaintance with this disease for a radiologist necessarily, since the exact recognition, followed by radical surgical intervention, is possible only with the help of x-rays.
The peculiarity of Brodnik is a localization in the spongy bone substance, and small or flat bones are almost never affected, and exceptionally large tubular bones, namely methyphizar ends. In the first place in the frequency of the disease, the articians of bones forming the knee, ankle and elbow joint. The most typical and favorite place of the localization of the gland is the tibia, which drops 80% of all cases, and the proximal metaphy is amazed more often than the distal one. The affectionant is preferably superficially under the cortex bone layer.
Abscess occurs in the metaphizar spongy substance in children's or youthful age, until the epiphyseal cartilage disk disappears. The process from the very beginning remains localized. The limited area of \u200b\u200bthe spongy substance is necrotic and slowly absorbed. Early and sharply pronounced reactive process around the purulent focus leads to the formation of a dense pyrogen sheath and osteosclerosis of the wastes of the waste. Therefore, the further increase in the cavity occurs extremely slowly - during the years and even dozens of years, and it stops at all when the walls reach a solid, non-donutory compact layer. After the excitement of the sprout cartilage, an affectionant from metaphysis is somewhat moving into the epiphysis.
The shape of the cavity is always the right spherical or oval with a long diameter coinciding with a long bone. The value is different, most often the cavity has a diameter of 2-3 cm. From the inside the cavity is lined with a dense leathery with a glotogeneic film (Membrana Pyogenica). The amount of pus is different. Rarely, it fills the cavity under pressure, sometimes has the character of the solar half-hazelnogric masses. In some cases, pum sterile, in others, after two and three decades after the start of the disease, the pus still contains virulent staphylococci.
Fig. 208. Chronic bone Abscess Brodie in the upper metaphy of tibia.
Fig. 207. Chronic Bone Abscess Brodie at a 22-year-old patient. It is sick of 7 years, periodically pain in the knee joint and "sympathetic" intermittent exudative drives. Operational and histological confirmation of the diagnosis.
It is characteristic of Brody's abscess significant osteosclerosis of the spongy substance surrounding the cavity, and only a very rarely, affiner lies among the normal spongy tissue. On the surface of the dice periosal layers are very insignificant, so if at all there is a cylindrical or, rather, the spindle-shaped thickening of the metaphiz at the uterine level, then only in the most moderate degree. As a rule, sequestration does not happen. Before the breakthrough outside or in the cavity of the neighboring joint, despite his proximity, it comes only in the rarest cases.
Of clinical features Brody's abscesses are most characteristic of an extremely long-term flow - up to two and three decades, bone pain, usually amplifying at night and after movement or exercise, as well as temporary swelling of soft tissues. Men are more often ill many times than women. The disease begins in most cases acute, but may also have a primary chronic current. In view of the proximity of the waste to the joint in many cases, articular phenomena are in many cases, which are so dominant in the entire picture of the disease, that the idea of \u200b\u200bthe primary disease of the bone and does not occur to a patient nor a doctor. These exudative synovites, or, as they are called, friendly, "sympathetic inflammation of the joints", have a mixed flow. Sometimes for long periods for several years, all the symptoms completely subside to suddenly appear again. The temperature remains normal, the picture of the blood does not change noticeable.
X-ray study has a decisive diagnostic value. All parts of the pathoanatomic painting of Abscess Brody are transmitted exactly and on X-rays (Fig. 207 and 208). Isolated, proper rounded shape cavity, without a sequestration, with sharply bounded smooth inner contours, located among the sclerosic spongy substance, on a typical place - in the metaphizar end of a large tubular bone, slightly thickened thanks to periosal layers, is this x-ray picture with support clinical symptoms Allows the diagnostic task. It should be noted that between, so to speak, the classic typical abscess of Brody and other forms of chronic osteomyelitis are transitional forms - and by location, sizes, form, nature of reactive changes in circumference, sequestration, etc. This is because in the nature of things : Classification shows always somewhat conditionally typical, life presents a variety that does not fit into a strict rigid scheme. In no way should be abused by the diagnosis of Brode abscess and put it expandingly, almost in all cases, more or less clearly pronounced cavity in conventional chronic osteomyelitis: Abood abscess is a completely defined clinical-x-ray-anatomical concept, this is a clear nosological unit, and diagnosis Justified only in cases where the X-ray picture satisfies all of the above criteria.
Differentiate the radiologically bone abscess is mainly with a banal chronic osteomyelitis, with a metatymphous osteitis, with a tuberculous focus, a gummy and bone cyst.
Ordinary vulgar osteomyelitis is distinguished by a more motion picture, great propagation, lush coarse perioditis, the presence in the cavity of a typical sequestration. Instead of a uniform rim of osteosclerosis surrounding the cavity of Brody's abscess, with osteomyelitis there is a motley algebraic amount of osteoporosis and osteosclerosis.
Metatymnial umnut does not reach such large sizes as chronic abscess brodes. In addition, it will never be nearing in the spongy in the long bones and often contains a sequest.
The tuberculous sax, even with a long-term benign flow, approaching it to the flow of an ulitnik, does not have the right, ball-shaped Ophid shape, does not reach such large sizes, is limited to non-in-depth internal circuits, contains a typical spongy sequestration, usually breaks out the outward or to the joint and t. d.
Isolated central gum also does not reach such large sizes like an affectionate. With a gummime defect there is no pyrogen shell, and the internal contours are not so smooth. In addition, only in the rarest cases, a large gummime focus remains solitary, isolated and bounded bone, especially in the spongy methyphys.
Bone isolated cyst eliminate easily. Cyst has big sizesThan the cavity of the Brody's washer, it gives a characteristic multi-chamber pattern with crossbars and partitions, which is never observed with an ulcer. The neighboring bone tissue is normal in counterweight osteosclerosis in abscess. In both diseases, the bone can be properly cylindrically thickened, but instead of the thickening of the cortical layer and the periostitis, with a radiographs, with fibrous osteodistrophy, its sharp thinning is detected. Even easier to be excluded in the distinctive recognition with the abscess of Brodi, sometimes solitary rounded enlightenment in the bone structure during fibrous osteodysplasia.
The error is accomplished also when Brodi's abscess is denoted by small salt-tagne, especially multiple aseptic necrotic cysts of a traumatic, postgemorgic and fatty nature.
In most cases, Brody's abscess, however, from the clinical side it is assumed not bone, and the articular disease. Here, differential X-ray diagnostics immediately resolves doubts, only the metaphizar edges of the bones were captured on radiographs.
Subacute piogenous osteomyelitis (sluggish infection is usually staphylococcus), often occurs in children in whom the defeat is usually localized in the proximal or distal metaphy of tibia and sometimes connects with a spark plate with a winding canal.
Epidemiology
It is found mainly in male people aged 20-30 years.
Clinical picture
Moderate pain, amplifying at night and after exercise. The general condition does not suffer.
Localization
Usually in methifes of long tubular bones. It is less likely to localize in the epiphyse, diaphysis, flat bones and bones of the wrong shape (for example, wrists and repulsed). The most frequent localization is the proximal metaphy of the tibia, then the distal metaphy of the femur.
Morphology
Usually single osteolatic, often oblong shape of the lesion with a sclerized edge. Typically rounded, clearly delimited osteolatic formation in epiphyshes. In the abscess diaphide can be detected in the center, subcortically or in the cortical layer. In the cortical layer, the abscess is surrounded by periosal newly formed bone tissue, simulating osteoid oste or "fatigue" fracture.
In a typical place, in the spongy methifise substance, a single focus of bone tissue destruction 2 3 cm in diameter, rounded or a few elongated shapes with relatively clear and smooth circuits, with the sclerosis zone in the adjacent bone tissue departments is revealed.
A.Abstes Brody. Multi-chamber osteolatic lesion with sclerosic edge in the proximal metaphy of tibia. The defeat in its uppermallion is connected to rostic zone Osteolatic defect (channel).
V.Abstes Brody. An oblong osteolatic lesion in the distal part of the tibia, surrounded by sclerotically modified tissues and minimally pronounced periostitis.
X-ray picture
Central enlightenment surrounded by slightly propagating reactive sclerosis. It is typically localized in metaphyshs and less often in epiphyse or diaphysis of tubular bones. In the abscess Brode can be detected, but not typical, the cortical thickening, the bone tissue and sequesters appropriately educated. Chronic, often painful education.
Differential diagnosis
Osteoid Osteoma. It is observed mainly in children's and young age. Male faces are 2 times more often. Patients complain of pains that gradually grow up for 1 1.5 years, intensify at night, can lead to sleep disorders. Pains are removed after taking aspirin. The tumor is localized mainly in the metadiafizarny department of a long tubular bone, more often than the tibial and femoral, less often in other bones.
Eosinophilic granuloma. In differential diagnosis with eosinophilic granulosa, it is necessary to take into account that for the abscess of Brodie is characterized by the localization of the process in the spongy substance of the metaphiz, and during the eosinophilic granuloma, the destruction is localized in any section of the long tubular bone, more often intra- and subcortic. In the abscess, Brody is characterized by the presence of a zone of reactive sclerosis around the destruction center and relatively smooth contours of the degradation. In case of eosinophilic granuloma, uneven potatoes of the contours of the destruction of degradation are often observed, sometimes with the sclerosis rim.
Tuberculosis spas. With tuberculosis, accelerate is characterized by the gradual increase in phenomena of tuberculous intoxication. There is a mixing chromotype, moderate passing pains, muscle atrophy, symptom of Alexandrov. X-ray picture. The focus of destruction with uneven, fuzzy contours can contain multiple small spongy sequesters, cooperosis of the surrounding bone tissue.
Histology
Histologically central accumulation of purulent or mucus fluid is surrounded by inflammatory granulation tissue and the abnation of spongy bone. Sometimes defeat in the center may contain a sequest.
Sources
- "Differential diagnosis of diseases of bones and joints" Tutorial. St. Peterburg, 1985. The training manual was prepared by the departments of radiology (head of the department - prof. M. K. Mikhailov) and radiology radiology (head of the department - prof. G.I.Vodina) Kazan State Institute of Improvement of Doctors named after V.I. Lenin.
