PMC6688143_01
An expansile lesion with intramedullary sclerosis in the metaphyseal-diaphyseal region on plain (a) AP and (b) lateral radiographs.
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(a) Significantly irregular cortical thickening and periosteal reaction is observed medially (large arrow) and the area with high fluid density and a thin sclerotic halo (small arrows) especially in the metaphyseal intramedullary region can be observed on the coronal MDCT image. (b) Hypodense areas accompanied by irregular thickening of the cortex (arrow) and common irregular periosteal reaction is observed in the intramedullary region on the axial MDCT image. (c) Periosteal reaction (arrow) accompanied by a thickening of the cortex on the sagittal MDCT MIP image.
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In the metaphyseal-diaphyseal region, a significant cortex thickness with an irregular contour and an accompanying periosteal reaction were observed. In the intramedullary region, areas surrounded with a sclerotic halo and a high fluid density were detected (Figure 2).
Hypointense and serpiginous appearance in the metaphyseal-diaphyseal intramedullary region which is typical for Brodie abscess. The thickness of the cortical bone and the accompanying periosteal reaction (arrow) is noteworthy on the coronal T1-weighted FSE image.
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On T1-weighted coronal images, a hypointense serpiginous appearance, which is typical for Brodie's abscess, in the metaphyseal-diaphyseal region of the tibia was seen (Figure 3).
A hyperintense cavitary lesion (thick arrow) which indicates Brodie abscess in the metaphyseal-diaphyseal intramedullary region and edema in the tibiotalar articular region can be observed on this sagittal T2-weighted TSE fat-suppressed image.
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On T2-weighted images, a hyperintense intramedullary cavitary lesion, which can be considered as a demonstrative sign for Brodie's abscess, was detected (Figure 4).
(a)-(f) T1-weighted pre- and post-contrast images on the axial, coronal and sagittal planes. Multiple hypointense lesions causing an expansion in the intramedullary region are observed (arrows). Peripheral enhancement like abscess lesions is noteworthy in post-contrast series (arrows). (c) and (d) The heterogeneous contrast in the soft tissue was considered as inflammation and edema (stars).
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The heterogeneous contrast enhancement in the soft tissue was thought to be due to inflammation and edema (Figure 5).
Granulomatous osteomyelitis. (a) Caseating granulomas with Langhans giant cells (black arrows) (H&E, x100). (b) Caseous necrosis (H&E, x200). (c) Langhans giant cell within a granuloma (black arrow) and necrosis near the granuloma surrounded by mixed inflammatory cells (H&E, x200). (d) Sequestrum (black arrow head) and granulomas (white arrow head) dispersed in inflamed granulation tissue (H&E, x40).
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Dead bone fragments (sequestra) were present within the inflamed granulation tissue (Figure 6).
Real-time polymerase chain reaction (Real-Time PCR) results and amplification curves for the M. tuberculosis (MTB) DNA. Blue curve represents the MTB, pink curve represents the non-tuberculosis mycobacteria (NTM) and dark red curve at the bottom represents the internal control. MTB curve is the first curve that passes the cycle threshold, indicating an MTB DNA positivity.
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However, M. tuberculosis-specific DNA was detected by real-time polymerase chain reaction (Real-Time PCR; Anyplex  MTB/NTM Real-time Detection Kit, CFX96  Real-Time PCR System; Seegene, Inc., Seoul, South Korea) performed on formalin-fixed paraffin-embedded (FFPE) tissue block (Figure 7).