Radiology Notes

My notes during radiology residency, fellowship, and beyond…

Archive for the ‘pelvic’ Category

Ankylosing Spondylitis

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  • HLA-B27 positive
  • M>F
  • adolescents
  • findings
    • bilateral SI erosion –> ankylosing
    • bamboo spine
    • large central joints > small peripheral
  • SI findings similar in spondylitis of inflammatory bowel (UC > Crohn’s and Whipple’s)
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    Written by lmwong

    January 21, 2010 at 7:45 pm

    Posted in arthritis, bone, msk, pelvic, pelvis, spine

    Congenital Hip Dysplasia

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    • US
      • superolateral displacement of hip relative to acetabulum
      • axial and coronal views
      • measure alpha angle, normal is >60 degress
      • stress maneuvers: abnormal posterior and superior subluxation
    • risk factors
      • family history
      • breech presentation
      • torticollis
      • foot and knee deformity
      • neuromuscular disease (myelodysplasia and arthrogryposis
    • F>M, L>R
    • screening exam at 4-6 weeks

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    Written by lmwong

    January 17, 2010 at 8:28 am

    Femoroacetabular Impingement

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    • impingement of anterior labrum during hip flexion and internal rotation
    • anterior osseous bulging of femoral head-neck junction
    • excessively deep acetabulum with overgrowth of anterior superior acetabular rim )pincer-type)
    • ~ herniation pit

    Written by lmwong

    January 15, 2010 at 9:56 pm

    Posted in bone, hip, msk, pelvic, pelvis

    Slipped Capital Femoral Epiphysis

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    • SCFE
    • Salter-Harris I fracture with displacement
    • capital femoral epiphysis slips posterior medial to neck
    • findings
      • widening of physis
      • Klein line (lateral femoral neck line) DOES NOT cross femoral head
      • indistinct physis
    • adolescents,¬†males, blacks, obese, children with delayed skeletal maturation
    • 20% bilateral
    • internal pinning WITHOUT reduction; do not disrupt blood supply
    • osteoarthritis in adulthood, risk of AVN

    Written by lmwong

    January 15, 2010 at 9:37 pm

    Posted in bone, hip, msk, pediatrics, pelvic, pelvis

    Hip Deformity Differential

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    • Avascular Necrosis
    • Congenital Hip Dysplasia
    • Legg Calve Perthe Disease
    • SCFE

    Written by lmwong

    January 15, 2010 at 9:30 pm

    Femoral fractures

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    • MRI has highest sensitivity, specificity
    • Bone scan highly sensitive after 72 hours
    • CT scan not as sensitive as MRI
    • femoral head fractures
      • associated with hip dislocation
    • femoral neck fractures
      • the most common
      • elderly, osteoporosis
      • types: subcapital (MC), midcervical, and basicervical
      • more displacement, higher chance of AVN and nonunion
      • Garden Classification of Subcapital fractures
        • Stage I = incomplete lateral impaction fractures
        • Stage II = complete subcapital fractures without displacement
        • Stage III = complete subcapital fractures with partial displacement
        • Stage IV = complete subcapital fracture with gross proximal displacement of the shaft relative to the head
    • intertrochanteric fractures
      • good prognosis
      • internal fixation with dynamic hip screw
    • avulsion fracture of less trochanter
      • pediatrics
      • superior avulsion of less trochanter, pulled by iliopsoas
    • femoral shaft fractures
      • often fragmented or butterfly
      • casting for pediatrics, intramedullary rod for adults
      • degree of rotation (version) is measured
    • femoral condyle fractures
    • stress fractures
      • detected on MRI
      • along medial femoral neck
      • become complete fractures, requiring pinning

    Written by lmwong

    January 15, 2010 at 9:23 pm

    Posted in bone, hip, msk, pelvic, pelvis, trauma

    Hip Dislocation

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    • ~ femoral head fractures
    • delayed relocation increases risk of AVN

    Posterior

    • most common, 90%
    • superior displacement of femoral head on frontal view
    • femoral head may look smaller

    Anterior

    • flexed =¬†obturator anterior dislocation
      • femoral head is medial and inferior
      • overlying obturator foramen
    • extended = iliac dislocation
      • head is superior to acetabulum
      • femur is externally rotated; distinguish from posterior dislocation

    Written by lmwong

    January 15, 2010 at 9:04 pm

    Posted in bone, hip, msk, pelvic, pelvis, trauma