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)

    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

    read more

    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


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


    • 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

    Medial Ureteral Deviation

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    Upper ureter:

    • Retrocaval ureter
    • Retroperitoneal fibrosis

    Lower ureter:

    • Lymphadenopathy
    • Iliac artery aneurysm
    • Bladder diverticulum
    • Post-surgical (esp. AP resection)
    • Pelvic lipomatosis

    Written by lmwong

    April 11, 2008 at 4:57 pm

    Pelvis Plain Film Dictation

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    Indication: [x]
    Technique: [x] views of the pelvis.
    Comparison: [x]
    Findings: No fracture or dislocation is seen. The hips joints, sacroiliac joints, and symphysis pubis are well-maintained.
    Impression: No osseous or articular abnormalities of the pelvis.

    Written by lmwong

    April 7, 2008 at 4:19 am

    Pelvis Ultrasound – Emergency department OB ultrasound Dictation

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    TECHNIQUE: Limited sonographic obstetrical examination for the basis of emergency evaluation. This exam is not in lieu of a formal anatomical obstetrical scan. The exam was performed transabdominally.
    *Transvaginal examination was also performed for assessment of the cervix.


    *Gestational Age: [x]
    Status: Alive or Demise
    Number: Singleton or Twin
    Activity: Present or Absent
    Position: Vertex, Breech, Tranverse head right , Tranverse head left, etc (if >25 weeks)
    Placenta: State position and whether previa or not (if > 16 weeks)
    Cervix: Cervix is greater than 3 cm and there is no funneling / Cervix is open and the residual cervix measures [x] cm
    Amniotic fluid: if >16 weeks
    Mild Oligo, Moderate Oligo, Severe Oligohydramnios
    Mild Poly, Moderate Poly, Severe Polyhydramnios
    Fetal cardiac activity: (Give FHR if <8weeks). Note as present or absent otherwise.
    Ovaries: Both Normal
    Right not seen, Left normal
    Left not seen, Right normal
    Both not seen
    Other findings: [x]
    *Basis for gestational age: LMP or EDC provided by patient

    Findings were discussed with [x].

    Written by lmwong

    April 7, 2008 at 4:08 am

    Pelvic Ultrasound Dictation

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    Indication: [x]

    Technique: A sonogram of the pelvis was performed utilizing [transabdominal and transvaginal] approaches assessing gray-scale appearance and color Doppler flow.

    Comparison: [x]

    The uterus measures [x] x [x] x [x] cm. No focal uterine masses are seen. The endometrium measures [x] cm in diameter.
    The right ovary measures [x] cm x [x] cm x [x] cm. The left ovary measures [x] cm x [x] cm x [x] cm. No adnexal lesion is seen. Normal right and left ovarian arterial and venous waveforms are idenitifed with normal resistive indices of [x] and [x], respectively.
    No free pelvic fluid is demonstrated.

    Impression: [x]

    Written by lmwong

    April 7, 2008 at 4:07 am