imaging final Flashcards
how many vertebrae in the lumbar spine
5
size difference between lumbar and cervical vertebrae
lumbar larger
articular surfaces oriented in sagittal direction
spinous processes shorter, thicker, and not visible on lateral projection
sacralization
only four lumbar vertebrae
lumbarization
6 lumbar vertebrae
standard views
AP
left oblique
right oblique
lateral
coned-down view of lumbosacral joint
coned-down view of L5-S1
x-rays must penetrate both sides of iliac bones so it subjects the highest dosage of rads of any plain film
lateral view of L5-S1
AP view of lumbar spine totem pole
vertebral body - bird’s head
pedicles - bird’s body
transverse processes - feathers from bird’s head
lamina and spinous processes - form bird’s beak
certain metastatic processes have predilection for vertebral pedicles, darkening one eye and resulting in winking owl
alignment in AP
spinous processes should align vertically
lateral surfaces of bodies line up vertically
bone density and dimension of AP
double lamina - sign of severe spondylolisthesis caused by inferior displacement of L5 on S1
left and right oblique of lumbar
patient supine, shoulders, lower spine and pelvis rotated toward side to be image
used to image spondylolysis
scottie dog in lumbar obliques
pedicles - dog’s eye
superior articular facet - dog’s ear
inferior articular facet - dog’s front legs
opposite superior facet - tail
opposite inferior facet - back legs
transverse processes - muzzle
pars interarticularis - neck
spondylolysis - collar around neck
lateral view of lumbar
spondylolisthesis: is anterior body aligned
grade 1: 25% displacement
grade 2: 50%
grade 3: 75%
grade 4: >75%
retrolisthesis
superior portion of spinal column moves posterior on inferior body
vacuum phenomenon
radiolucent area in synovial joints, IVD and vertebrae
explained by gas accumulation (nitrogen)
spondylosis deformans
well preserved disk spaces and significant spurring of anterior body
calcification of sharpey’s fibers
angle that shaft of femur is offset to acetabulum
130
bones that form pelvis
iliac wings
pubic bones
ischial bones
angle of inclination
normal 125
coxa vara 105
coxa valga 140
standard views for hip and pelvis
AP
frog leg
AP hip position
pt supine and hip internally rotated 15 degrees
frog leg position
pt supine, knees flexed, femurs abducted
does not rule out fracture or dislocated hip
iliopubic line
from midpoint of inner rim of pelvis distally along medial rim of pelvis toward pubic rami
ilioischial line
runs from midpoint of inner rim of pelvis and runs distally along medial border of teardrop to medial border of obturator foramen
teardrops
represent sum of shadows created by acetabular walls
center edge angle
line drawn from center of femoral head vertically
line drawn from center of femoral head to lateral edge of acetabular rim
angle >25 degrees
shenton’s line
from medial edge of proximal femur metaphysis proximally and medially along proximal rim of obturator foramen
normally smooth
other alignment in hip
are iliac crests level
are pubic rami aligned
are femurs equally rotated
are greater trochanters level proximally
bone density in hip
sclerosis resulting from bone on bone articulation when cartilage damaged or worn
increased density in stress injury
rapidly growing tumor shows sunburst pattern
four trabecular patterns in femur
principle compressive group
secondary compressive group
principle tensile group
secondary tensile group
ward’d triangle
formed by PC, PT, SC
enlarged in osteopenia
calcifications in soft tissue
dystrophic causes 95-98% of the time
2-5% - chondrocalcinosis, or tumor
congenitally dislocated hip
2-3 yo
more in girls
80% unilateral
septic hip
systematic symptoms of fever, pain, sepsis
children limp and have vague thigh pain
legg-calve-perthes disease
3-12 yo
AVN, more in boys
1 in 1200
may have high groin pain
melted ice cream cone
slipped capital femoral epiphysis
adolescent
most frequent cause of hip pain in this age group
growth plate
labral tears and acetabular fracture
clinical manifestations of hip protrusion or shallow acetabula
osteoarthritis
middle age and older
osteoporotic prone to falls
dislocations
result of shallow acetabula
trauma
following THA - commonly misses
which way is the majority of hip disloactions
posterior
occult fractures
may be result of low impact or repetitive impact injuries
osteonecrosis
AVN
first sign in children - osteoporosis
first sign in adults - sclerosis or crescent sign
femoroacetabular impingement
decreased offset between neck and head combined with retroversion of head
myositis ossfifcans
visible 2-4 weeks post injury
pain, swelling, hematoma
loss of blood to quads
increased density in femur
standard views of knee
AP
lateral
sunrise
tunnel
AP knee
demonstrates medial and lateral alignment of patella relative to femur
pt supine and beam angled 6 degrees cephalad
lateral knee
femoral condyles should be superimposed
pt SL and knee flexed 20-35 degrees
sunrise view
visualize patella in groove
tunnel view
show intercondylar notch between condyles
knee flexed 40-50 degrees
standard views of ankle
AP
lateral
mortise
ap ankle
lateral tibia overlays distal fibula
15-20 deg external rotation
lateral ankle
plafound, talus, medial malleolus, calcaneus, tarsal
mortise view of ankle
no overlay of fibula
tibial fracture
fracture in tibia
fibular fracture
fracture in fibula
jones fracture
fracture of the 5th metatarsal
dancers fracture
tendon pulls of part of bone of 5th metatarsal
osteochondritis dissecans
a joint condition in which bone underneath the cartilage of a joint dies due to lack of blood flow
