非典型Brodie骨脓肿的影像学与临床表现

Radiological and clinical findings of atypical Brodie′s abscess

目的探讨非典型B rod ie骨脓肿的临床表现、影像学诊断与鉴别诊断。方法分析29例经手术和其它治疗证实的B rod ie骨脓肿的放射学和病史资料,包括X线、CT和MR I资料,研究其中14例非典型B rod ie骨脓肿的影像学和临床表现,分析其诊断要点及误诊原因。结果14例非典型B rod ie骨脓肿中单发11例,多发3例,有9例发生误诊,其中3例误诊为骨结核,4例误诊为骨样骨瘤,2例误诊为骨母细胞瘤。不典型表现为:发生部位不典型、硬化环不连续或硬化区域较大,骨破坏区内密度混杂,有骨膜反应和软组织肿胀;15例典型的B rod ie骨脓肿表现为长骨干骺端小圆形或椭圆形均匀透亮破坏区,周边见高密度硬化环,无骨膜反应。结论B rod ie骨脓肿影像学表现多样,临床表现无特异性,容易误诊,应与骨结核、骨样骨瘤和骨母细胞瘤等仔细鉴别。

Objective To explore the imaging and clinical findings of atypical Brodie＇s abscess and its differential diagnosis. Methods 29 cases of Brodie＇s abscesses comfirmed by operation or other treatment methods were enrolled. Radiology and clinical findings in 14 atypical Brodie＇s abscesses of 29 were studied. Radiological films including X ray, CT and MRI were studied in order to character its findings and its diagnosis as long as differential diagnosis were analyzed. The causes of misdiagnosis were analysed also. Results 11 of 14 atypical Brodie＇s bone abscess were solitary lesion,while 3 of 14 were multi-lesions at the bone. 9 of 14 cases were misdiagnosted（64% ,9/14） ;3 of 9 were regarded as bone tuberculosis,4 cases were regarded as osteoid osteoma,2 of them were misdiagnosis as chondroblastoma. 15 of 29 cases in the study group showed typical round or oval shape transparent area with high density sclerosis circle along the lesion with no sub-periosteal reaction. 14 cases showed atypical location and atypical findings ：continous sclerosis circle, mix density in the lesion and sub-periosteal reaction with soft tissue swelling. There were no clinical characteristics in both typical and atypical groups. Conclusions Brodie＇s abscess is seldom found with lesions of multi-features in radiology. It＇s had no clinical characteristics, and easily be misdiagnosted. It should be differentiated with bone tuberculosis, osteoid osteoma and chondroblastoma and so on.