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Differential Diagnosis > Radiologic Exam of Pelvis and Hip > Flashcards

Radiologic Exam of Pelvis and Hip Flashcards

1
Q

Signs and Symptoms of slipped femoral capital epiphysis (SFCE):

  1. Vague pain in ___ or ____
  2. Limited _____
  3. _____ leg and limp
  4. _____ onset
  5. twice as common in boys => _____ and delayed maturation are common characteristics
A
  1. hip or knee
  2. limited ROM
  3. Shortened leg and limp
  4. insidious onset
  5. obesity
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2
Q

Fractures to the proximal Femur

  1. ____ = in capsule
  2. ____= out of capsule
A
  1. Intracapsular
  2. Extracapsular
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3
Q

Which type of imaging is uses to typically assess hip fractures?

A

Convential Radiographs

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4
Q

The image is an example of which type of MRI and which imaging plane?

A

T2 coronal MRI hip

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5
Q

Which imaging plane allows for visulization of the following with CT of the hip:

  • anterior inclination of acetabular cup
  • acetabular roof
  • iliopsoas muscle
  • sacroiliac joints
  • pubic symphysis
A

Sagittal Plane CT of Hip

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6
Q

Radiographic eval of avascular necrosis

  1. ____ = appear normal for several weeks
  2. ____ = identify increased uptake soon after injury
  3. ____ = earliest senstivity and specificity => considered most appropriate study
A
  1. Radiographs
  2. Bone scans
  3. MRI
  • on image, you can no longer see ball and socket => arrows are pointing to “cresent” sign = sign which shows the collapse of subchondral bone
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7
Q

Which imaging view of the hip is described by the following:

  • greater trochanter is superimposed behind the neck
  • lesser trochanter is anterior
A

Lateral Frog-Leg

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8
Q

Different presentations of avascular necrosis of the hip:

  1. _______ _____ = localized
  2. _____ _____ _____ = affect entire epiphysis
A
  1. osteochondritis dissecans
  2. epiphyseal ischemic necrosis
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9
Q

Stable fractures

  1. ____ is often the direct result of an impact to the iliac crest due:
  • to contact during sporting activity
  • fall onto hip
  1. this injury could result in a bruise or ____ fracture.
A
  1. Hip pointer
  2. avulsion fracture
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10
Q

Classification for trauma to the pelvis

  1. ___ = low energy injuries (no disruption to joint)
  2. ___ = high energy injuries
A
  1. stable
  2. unstable
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11
Q

Posteromedioinferior displacement of the proximal femoral epiphysis that occurs during childhood or adolescence

A

Slipped Femoral Capital Epiphysis

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12
Q

DJD of the Hip

  1. ___ = develops without a precursor
  2. ___ = pre-existing conditions include:
  • paget’s
  • fracture
  • epiphyseal disorders
  • congential dislocation
  • avascular necrosis
  • other inflammatory arthritides
A
  1. Primary
  2. Secondary
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13
Q

Complete the following ABCDs for MRI at the hip:

  1. Alignment and Anatomy = head/neck of femur ____ and alignment
  2. Bone density = ____ signal intensities (e.g. bone brusies or marrow edema)
  3. Cartilage Space: normal appearnce of labrum, tears will image as a ___ ___ signal
  4. soft tissues = edema = ___ look for inflammatory components (bony and soft tissue)
A
  1. contour
  2. irregular
  3. high bright signal
  4. T2
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14
Q

_____ _____ of the hip = complicated process initiated by an interrupted blood supply causing tissue death

A

Avascular necrosis

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15
Q

Complete the following ABCDs for CT at the pelvis and hip

  1. Alignment and Anatomy = ____ or dislocation
  2. Bone Density = ____ of bone; breaks in corticol margins
  3. Cartilage Space = Loose bodies or free fragments (not visible unless with ____); spacing betwen femoral head, acetabulum, and labrum
  4. Soft tissues = ____ (most commonly seen with deistension of bursa and joint capsule)
A
  1. fracture
  2. destruction
  3. arthography
  4. effusion
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16
Q

Which imaging view of the hip assesses the following:

  • shenton’s line = big arch that forms a part of the obturator foramen
  • iliofemoral line = look for smooth curve off of ilium onto the neck of the femur
  • Femoral neck angle = decrease in angle could indicate fracture
  • disruptions associated with fracture
  • dislocation (e.g. SCFE)
A

AP HIP

  • Shenton’s line = orange
  • Iliofemoral line = green
  • Femoral Neck angle = red
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17
Q

Which imaging view assesses for the following at the pelvis:

symmetry

  • equal size of ililiac ala
  • equal size obturator foramina
  • sacral symmetry
  • sacrum, occyx, pubic symphysis aligned
  • femoral head line
A

AP Pelvis

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18
Q

DJD of the hip: clinical presentation

  1. Aymmetrical ____ ____ narrowing
  2. Sclerotic _____ bone
  3. Osteophytes at ___ _____
  4. ___
  5. Migration of the ____ _____
A
  1. joint space
  2. subchondral bone
  3. joint margins
  4. cyst
  5. femoral head
19
Q
  1. The MRI protocol for the hip uses which 3 image views?
  2. FOV = entire pelvis and hips => ____ to the ____
A
  1. axial, sagittial, and coronal
  2. iliac crests to the lesser trochanters
20
Q

RA of the Hip

  1. Osteoporosis of ______ area
  2. Symmetric and Concentric _____ ____ narrowing
  3. _____ erosions
  4. ____ ___ in nearby bone
  5. ____
  6. Axial migration of ____ ____
  7. Acetabular _____
A
  1. periarticular area
  2. joint space narrowing
  3. articular erosions
  4. synovial cysts
  5. effusion
  6. femoral head
  7. acetabular protrusion
21
Q

The following are all indications for which type of imaging at the pelvis and hip:

  • severe trauma
  • fracture fragments
  • loose bodies
  • fractures of acetabulum or sacrum
  • congential hip dislocations or joint replacements
A

CT scan

  • also indicated for use if MRI is contraindicated
22
Q

The image is an example of which type of MRI image of the hip?

A

Arthrogram (Arthrography) MRI of Hip

23
Q

Routine imaging series

  1. Pelvis = ?
  2. Hip = ?
A
  1. AP
  2. AP and Lateral Frog-Leg
24
Q

Unstable Pelvis Fractures: on the image,

What types of fractures/injuries on depicted?

A
  • A, B, C = vertical sheer fractures
  • D = straddle fracture
  • E = bucket-handle fracture
  • F = “open book” injury
25
Q

Fractures of proximal Femur

  • Intracapsualr
  1. Potential injury to circumflex ____ arteries
  2. post-op complications including AVN and ____ (altered blood flow)
  3. to treat, younger = ____; older = _____
  • Extracapuslar
  1. Intertrochanteric make up ____ of proximal femur fractures
  2. treatment = ____
A

Intracapsular

  1. circumflex femoral arteries
  2. AVN and non-union
  3. younger = ORIF; older = THA

Extracapsular

  1. 50%
  2. ORIF
26
Q

Which variation of MRI will allow for additional assessment of intra-articualr distension that will help identify labral tears or impingement disorders?

A

arthrography

27
Q

Which imaging plane allows for visulization of the following with CT of the hip:

  • Bilateral hip joints
  • Femoral heads, necks, shafts
  • Greater and lesser trochanters
  • sacrum
  • ilia
  • SIJs
A

Coronal Plane CT of Hip

28
Q

On the image:

  1. A = asymmetrical loss of ___ ___
  2. B (upper) = marginal _____
  3. B (lower) = ___
  4. C = sclerotic _____ bone
  5. D = loss of articular cartilage has caused the ____ of the femur to migrate superomedially (bone bulge)
A
  1. A = asymmetrical loss of joint space
  2. B (upper) = marginal osteophytes
  3. B (lower) = spur
  4. C = sclerotic subchondral bone
  5. D = loss of articular cartilage has caused the head of the femur to migrate superomedially (bone bulge)
29
Q
  1. Axial MRI used to diagnose ____.
  2. Alpha angle of the head-to-neck is assessed on ___ ___ view.
  3. Cam, pincer, or mixed type of femoroacetabular ____ can be evaluated.
A
  1. FAI
  2. axial oblique
  3. impingement
30
Q

What is the FOV for CT at the hip?

  1. Pelvis from ____ to ____
  2. bilateral ____
  3. One ____
A
  1. Pelvis from ilium to ischium
  2. Bilateral hips
  3. one hip
31
Q

Which imaging plane allows for the visualization of the following structures with MRI for the hip:

  • acetabulum
  • labrum
  • pulvinar (tissue around acetabulum fossa of hip)
  • Femoral head and neck
  • greater and lesser trochanters
  • sacrum
  • ilium
  • SIJs
  • Pubic smphysis
A

Axial MRI of Hip

  • image is an example of T2 => T1 can also be used to see urinary bladder and synovial fluid in joint space
32
Q

The image is an example of which type of MRI and which imaging plane?

A

T1 Coronal MRI of Hip

33
Q

The image is an example of which MRI view of the hip?

A

Coronal MRI of Hip

34
Q

Which imaging plane allows for visulization of the following with CT of the hip:

  • femoral head in acetabular fossa
  • medial wall of acetabulum
  • anterior and posterior rims of acetabulum
  • sacrum
  • pubic rami
  • greater and lesser trochanters
A

Axial Plane CT of Hip

35
Q

Stable trauma to pelvis

  1. most fractures seen in ____

Unstable trauma to pelvis

  1. fractures to ___ or more sites of the pelvic ring
  2. associated ___ damage makes this potentially life-threatening
  3. assessed quickly with ___ (thorax, abdomen, pelvis)
A
  1. AP
  2. 2 or more sites
  3. visceral damage
  4. CT
36
Q

Radiologic findings of SFCE:

  1. ___ view shows blurring and widening of epiphysis
  2. _____ view demonstrates amount of displacement
A
  1. AP
  2. Lateral frog-leg
  • Note; on image, black dots denote normal epiphyseal contour on the R
37
Q

Radiographs are initial study. Then:

  1. Radiographic findings may be ____ to diagnose the condition and direct treatment, OR
  2. Radiographic information is expected to be ____ for completion of the diagnositc picture because
  3. Radiographs are limited to indentifying ____ changes in bone density, AND
  4. are unable to differentiate the ___ ____ with any specificity.
A
  1. sufficient
  2. insuffcient
  3. late changes
  4. soft tissues
38
Q

Etiologies of avascular necrosis of the hip:

  1. External vessel _____ (trauma, infection, steroids)
  2. _____ of vessel walls (radiation, lupus, giant cell arthritis)
  3. ______ processes (alcoholism, diabetes, sickle cell disease)
A
  1. external vessel compression
  2. thickening of vessel walls
  3. thromboembolic processes
39
Q

Unstable pelvic fractures: trauma to the acetabulum

  • Most common mode is impaction of the femoral head into the acetabulum
  • label the types seen in the image
A
  • A = anterior (in front of acetabulum)
  • B = Posterior (behind the acetabulum)
  • C = Transverse (across)
  • D = T-shaped

Classification is determined by the potential for serious harm

40
Q

Stable Fractures: On the image,

  1. white arrows indicate a ____ fracture
  2. small black arrows indicate an ____ fracture
  3. large black arrow indicates a fracture of the inferior ____
  4. Combined with significant swelling of the left hip and upper thigh, this presentation is known as a _____ fracture
A
  1. complete transverse fracture = white arrows
  2. impaction fracture (small black arrows)
  3. fracture of inferior acetabulum (large black arrow)
  4. dashboard fracture/injury = bent knee causes impact of head of femur into acetabulum
41
Q

What are the 3 basic imaging planes for CT of the hip?

A
  • Axial
  • Sagittal
  • Coronal
42
Q

CT, MRI, and bone scans are more useful for ____ ____(negative radiographs but suspicions are still high).

A

Occult Fractures

43
Q

Indications for the use of MRI at the Hip is to help give direct visualization of anatomy, namely

  1. ___ changes
  2. Bone ____ disease
  3. ____ fractures (hidden)
  4. Childhood hip disorders and _____ deficits
  5. _____ and labral involvement
  6. Bursitis/inflammation in ____ (e.g. herniation)
  7. Osteochondral ____
  8. ____ involvement (nerve)
A
  1. Avascular changes
  2. Bone marrow disease
  3. occult fractures
  4. childhood hip disorders and long-term deficits
  5. impingement and labral involvement
  6. bursitis/inflammation in soft tissues
  7. osteochondral abnormalities
  8. sacrul plexus involvement
44
Q

The image is an example of which MRI view of the hip?

A

Sagittal MRI of Hip

Differential Diagnosis (11 decks)

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