Radiology of the Pelvis Flashcards
Identify the indidcated features of the pelvis
What view is shown in the provided image?
Normal AP Radiograph
Identify the indicated contou lines
What features are being pointed out by the lines on the radiograph?
This radiograph is in what view?
What is the importance of the normal pelvic inlet radiograph?
- Help detect:
- anterior or posterior displacement of bony pelvis structure
- rotation deformities
- sacral arch fractures
The provided radtiograph is in what view?
What are the benefits of this view?
Normal pelvic outlet radiograph
- Help detect
- hemipelvis elevation / superior or inferior displacement of bony pelvis structures
- sacral fractures
- SI joint widening
What is the most common method for classification of pelvic ring injury?
Young and Burgess classification
3 different types based on the direction of the force
- lateral
- stable (can support own weight & not do damage to themselves)
- rotationally unstable, vertically stable
- globally unstable
- anterior/posterior
- stable
- rotationally unstable, vertically stable
- globally unstable
- vertical shear
- visceral injuries, unstable
- combined
- variable
What tyep of ring injury is shown in the provided image?
Lateral compression type 1, AP radiograph
What type of fracture is shown in the provided image?
Arcuate line fracture
What type of pelvic ring fracture is shown in the provided image?
WHta
What type of fracture is shown in the provided image?
see a fracture on both side
What type of pelvic ring injury is shown in the provided image?
diastasis < 2.5 cm
What type of pelvic ring injury is shown in the provided image?
once the pubic symphysis diastasis is > 2.5 cm,
the sacrospinous & sacrotuberous ligaments are also ruptured
probably on a board
What type of pelvic ring injury is shown in the provided image?
additionally posterior ligaments of the SI joint
What type of pelvic ring injury is shown in the provided radiograph?
notice that the diastasis is not level
will rip sacrotuberous/spinous ligaments & anterior/posterior ligaments of the SI joint
What contour lines are shown in the provided radiograph?
They indicate what structure?
- yellow: ileopectineal line
- going to the pubic bone (anterior)
- purple: ileoischial line
- going to ischial tuberosity (posterior)
- green: anterior rim of acetabulum
- red: posterior rim of acetabulum
Identify the indicated regions
Identify the type of elementary acetabular fracture
What type of view is shown in the provided radiographs?
What is the usually appropriate next steps for
“Penetrating trauma, lower abdomen and pelvis. Suspected lower urinary tract trauma. Initial imaging”
Fluroscopy retrograde cytogrophy
CT pelvis with bladder contrast (CT cytography)
The provided image is an example of what imaging modality & what is the purpose of it?
- Retrograde cystogram
- catheter inserting fluid into the bladder the “wrong way”
- looking to see if any of the contrast leaks out
- Retrograde urethrogram
- same thing, looking for rupture of the urethra
What imaging technique is shown in the provided image?
Why is this type of imaging performed?
- CT cystography
- insert catheter & inflate the bladder balloon with
- looking for leakage in the fascial planes
What is the appropriate procedure for an adult or child with acute onset of scrotal pain. WIthout trauma, without antecedent mass?
What are you looking for?
US duplex doppler scrotum
Torsion vs. infection / Complication?
If torsion, about 6 hrs before lose testicle
Age of patient is important
What is the most common cause for acute scrotal pain in patients?
Epididymitis
Common in patients 19-25 & is overwhelmingly the etiology for acute scrotum pain in patients >25 yrs
Where should you assess the scrotum when determining epididymitis?
The infection travels retrograde (tail, body, head, then testicle - so assess the tail)
What clinical problem is shown in the provided image?
Epididymo-orchitis
infection of the epididymis & the testicle
important to look at both testicles
What types of things are you looking for when assessing the testicles?
What complication can occur?
increased size
increased flow
epididymitis complication (abscess- unusuall, but may require surgery)
What is the most common cause of acute scrotum pain in children?
Torsion - torsion of appendages or testis or epididymis
can be difficult to see by US
What problem is shown in the provided image?
It is most common in what demographic?
Torsion
most common in adolescent boys
rare in patients >35 years of age
What problem is shown in the provided image?
a true surgical emergency
~6 hours viability
“whirlpool sign”
What diagnostic steps would you take if someone came in with acute pelvic pain int he reproductive age group and pregnancy is suspected b/c B-hCG positive?
US pelvis transvaginal (more detailed view)
US pelvis transabdominal (wider view)
both should be performed
a situation of serum B-hCG >3510 mIU/mL and absence of an intrauterine gestational sac is suggestive of what?
ectopic pregnancy
Whta is shown in the provied images?
ectopic pregnancy
only way to definitely diagnose ectopic pregnancy is to find fetal pole & measure heart rate
What is shown in the provided images?
interstitial ectopic location
What is shown in the provided image?
lower uterine segment / cessarian scar ectopic
What is shown in the provided image?
cervical ectopic
What is shown in the provided image?
In what situations is this most common?
Heterotopic pregnancy - one eutopic & one ectopic
invitro fertilization
What are the most consistent findings wiht ovarian torsion?
enlarged, edematous ovary or ovarian complex consisting of an ovary & associated adnexal mass
- tissue edema
- absecence of intravovarian vascularity
(initially, blood flow can be present)
What is shown in the provided image?
Ovarian torsion
a lot of flow on the outside, but not really on the inside
What is the most appropriate step when a patient come in wth clinically suspected prostate cancer, no prior biopsy (biopsy naive)
TRUS-guided biopsy prostate
transrectal ultrasound-guided biopsy
What is the more modern way to assess for prostatic lesions?
Multiparametric prostate MRI / Prostate specific MRI
looks w/ conventional & functional MRI (diffusion weighted)
What is shown in the provided image?
mutiparametric prostate MRI
T2 axial looking for somethign low signal (arrow)
T2 coronal looking for low signal intensity (arrow)
DCE (dynamic contrast enhanced) wash out sooner
DWI (diffusion weight imaging) ADC will look dark, on regulation diffusion willl look bright
What imagaing is performed during a multiparametric prostate MRI?
Describe the sectoral map of the prostate according to PI-RADS
- conventional imaging
- T1 and T2 axial & coronal
- plus functional imaging
- DWI and DCE sequences
- Sectoral map
- PZ: peripheral zone
- CZ: central zone
- TZ: transitional zone
- US: urethral stroma
- AFS: anterior fascial stroma
- 98% of cancer will be in peripheral zone with most of the rest in the transitional zone
What is the appropriat next steps for a patient with prostate cancer follow-up. Status post radical prostectomy. Clinical concern for residual or recurrent disease.
C-11 choline PET/CT skull base tom id-thigh
MRI pelvis without and with IV contrast
F-18 fluciclovine PET/CT skull base to mid thigh
What is the benefit of a CT-PET fusion?
tells you if a strucuture is metabolicaly active
