Kamsi
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A 7-year-old boy who has had pain in his right leg for 4 months is being evaluated in the
pediatric clinic. The pain is worse at night and is unrelenting, but it can usually be relieved with
ibuprofen. According to his parents, he is a physically active child and plays basketball and
little league softball. On physical examination, there is localized tenderness over the anterior
aspect of the right thigh. There is also mild atrophy of the affected limb. A radiograph of the
femur reveals a radiolucent nidus with surrounding reactive sclerotic bone. Which of the
following is the most likely diagnosis?
A. Brodie's abscess
B. Ewing sarcoma
C. Osteosarcoma
D. Osteoid osteoma
E. Stress fracture
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| DrVirgo
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A. Brodie's abscess
The clues are:
pain is worse at night
usually be relieved with ibuprofen
localized tenderness
reactive sclerotic bone
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| Doc750
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Agreed A. Brodie's abscess. Also look for the classic presentation of a draining abscess extending from the tibia out through the shin
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| titly
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not stress fracture??
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| hanialkhadher
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D. Osteoid osteoma 
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| cinammonice
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D
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| DrVirgo
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What makes you say D?
Can you please explain?
Kamsi, what's the answer?
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| bigdino
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Typical picture of osteoid osteoma. He is a child with pain worsening at nights, relieved by NSAIDs, radiolucent nidus and reactive sclerosis (Classic radiologic finding; i am a radiologist so I better know about). I suppose being a physically active child would exclude an abscess.
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| DrVirgo
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bigdino wrote:
Typical picture of osteoid osteoma. He is a child with pain worsening at nights, relieved by NSAIDs, radiolucent nidus and reactive sclerosis (Classic radiologic finding; i am a radiologist so I better know about). I suppose being a physically active child would exclude an abscess.
Thanks for the explanation, I appreciate your input as a radiologist. Just wondering -aren't these findings also present in Brodie's abscess? How can we rule that one out?
Thankls.
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| bigdino
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They actually look quite similar on radiography and they would be included in the radiological differential. But the pain that gets worse at night is so classic of osteoid osteoma. Brodie's abscess is not associated with that nocturnal pain. Hope that helps 
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| kpmle2
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D. Osteoid osteoma
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| me007
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http://bonetumor.org/tumors/pages/page13.html
http://www.e-radiography.net/radpath/b/brodies_ab...
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| DrVirgo
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Thanks...
 still a bit confused...
This is from emedicine about Brodie's Abscess: http://www.emedicine.com/orthoped/topic27.htm
"Night pain that is relieved with aspirin is frequently reported."
"On clinical examination, localized tenderness may only occasionally be associated with warmth, redness, and soft tissue swelling with the involvement of subcutaneous bone."
"Type Ia lesions present as a punched out radiolucency often suggestive of eosinophilic granuloma. Type Ib lesions are similar to type Ia lesions but have a sclerotic margin and appear as a classic Brodie abscess."
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| neuroblastoma
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yes D
BECAUSE...IN BRODIES ABCESS-Minimal loss of function is another common symptom (eg, limping in a patient with a lower limb lesion),
in ques- physically active child
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| Kamsi
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D Osteoma from d hx of nocturnal pain n X-ray finding of radiolucent nidus with surrounding reactive sclerotic bone.
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| DrAlex_76
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wata question !
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| mytime
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Yes, D!!!!!!!!!! 
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| Ivonne
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UW question a nice one
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