Ankle and Foot 47 - Department of Radiology - University of ...

A
B
C D E
T1
T2fs
T1fs
IVGd
F G H
Figure 47-116. Brodie’s abscess in a young child. A, Anteroposterior radiograph of the asymptomatic right leg. B, Anteroposterior radiograph of
the swollen left leg reveals a lucency in the distal fibula metaphysis (arrow in the magnified dashed box). This lucency has a well-defined and
sclerotic margin, indicating chronicity. There are also thick, chronic periosteal reactions (arrowheads) extending up the diaphysis. C, Coronal
T1-weighted image through the distal fibula confirms the radiographic findings of a thick chronic periosteal reaction (white arrowheads), as well as
the well-circumscribed dark line (open arrowheads) around the lesion corresponding to the sclerotic margin. D, The corresponding coronal
T2-weighted fat-suppressed image shows that the well-circumscribed lesion (arrow) is as bright as fluid and thus probably cystic. E, The
corresponding coronal T1-weighted fat-suppressed post–intravenous (IV) gadolinium contrast image not only confirms that the lesion (arrow) is
mostly nonenhancing and thus mostly cystic, but demonstrates peripheral enhancement, in some places thick (black arrowhead), characteristic of
an abscess, in this case an intraosseous or Brodie’s abscess. (There is inadequate fat suppression of the heel pad [large white arrowhead] on both
of the fat-suppressed sequences, D and E.) F to H, Axial images through the fibular abscess reveal it to be isointense to muscle on T1-weighted
image (F, arrow) and fluid bright on T2-weighted fat-suppressed image (G, arrow), with peripheral but not central enhancement on fat-suppressed
T1-weighted image after IV gadolinium (H, arrow). There are edema and enhancement of the soft tissues surrounding the fibula, indicating an
active inflammatory component to this chronic Brodie’s abscess.
Ch047-A05375.indd 2311
9/9/2008 5:36:20 PM