Radiology of the Pelvis and Lower Limb Flashcards
What is ordered as an initial examination of the pelvis
flat upright film PA radiograph
What skeletal landmarks should be recognized on a pa radiograph (10)
sacroiliac joints sacrum iliac wings pubic symphysis ASIS AIIS Obturator foramen superior pubic rami Inferior pubic rami Ischium
SSSIIIAAPO
What skeletal landmarks should be identified on CT (7)
sacroiliac joints sacral neural foramina sacral wings iliac wings acetabulum superior pubic rami inferior pubic rami
AIISSSS
What soft tissues structures should be identified on a CT scan of the pelvis
Urinary bladder
prostate/seminal vesicles in males
uterus in females
what gives the rectum a bubbly appearance
presence of stool and as such small gas pockets
What is the type of plane film used to visualize the uterine cavity and the uterine tubes
hysterosalpingograph
contrast introduced into vagina and uterus
What would be used to evaluate the uterus for masses and congenital anatomic variations (bicornuate uterus affecting fertility)
MRI
What would be used to asses the prostate gland in the setting of prostate cancer
MRI
What would be used to image suspected ovarian or uterine pathology
Utrasound
What would be used for obstetrical evaluation of the fetus
Ultrasound
What imaging method would be used to visualize the testis
Ultrasound
What is “the window” to visualize structure in pelvis with ulrasound and why
Urinary bladder
because sound travels well through liquid
How are suspected ovarian masses best evaluated
ultrasound
What can be placed near the uterus and ovaries allowing for better images
endovaginal ultrasound probes
What are the typical views of the hip that are obtained
AP and “frog leg” lateral views
What is the “frog leg” lateral view
frontal view obtained with leg abducted and externally rotated
What does the “frog leg” lateral view allow for best visualization of
anatomic neck of proximal femur (common site of femur fractures)
What is the relation of the posterior acetabular lip to the anterior acetabular lip on a frontal film and why
it is sloped so
posterior is seen inferior to anterior
What three bones make up the acetabulum
illium
ischium
pubis
What covers the femoral head
hyaline cartilage
Where is the femoral head not covered by cartilage
fovea (site of ligament attachment)
What is the best imaging for avascualr necrosis
MRI
What is a frequent site of fracture especially in elderly
femoral neck
What film has issues identifying femoral neck factures , what is used in addition then
plain films
MRI or CT is often perforemd
What has the greatest sensitivity in iding nondisplaced femoral neck fractures
MRI
What is the most common direction for femoral disslocation and what normally associates with it
Posterior
Associated fracture of posterior acetabulum
What actions usually cause posterior dislcoations of the femur
Motor vehicle accident (dashboard drives femur posteriorly)
What actions usually cause anter dislcoations of the femur? how are anterior dislocations different from posterior
abduction and external rotation of the hip
Not associated with fractures
What are the typical views obtained of the knee
Lateral
AP
Tunnel
Sunrise
LATS
What is the knee a frequent site of
fracture and ligamentous inury
What can plain films reveal and not reveal about a knee
Can reveal prescence of fracture or effusion
Cant: ligamentous and meniscal injury (due to radioleucency)
What is the largest sesamoid bone in the body
Patella
What does the patella articulate with
distal anterior femur at patellar groove
How is the patella best assessed when using plain films
using lateral and sunrise views
What is the main imaging for identifying ligamentous and meniscal injuries preoperatively
MRI
What is the best imaging for diagnosing cruciate ligament tears
MRI
What are the standard vies for the ankle
AP
Lateral
Oblique
What should be observed onthe oblique view
entirety of ankle joint space should be symmetric
What is a site of fequent fracture with ankle injuries and which view should be used to evaluate it
base of 5th metatarsal
lateral view
What bones are located directly inferior to the head of the 1st metatarsal
2 sesamoid bones
What are 4 ways to nonivasively study the vessels of the pelvis and lower extremity
Doppler
Ultrasound
Nuclear medicine techniques
Magnetic resonance Angiography (MRA)
How is the arterial system generally studied
injection of radio opaque contrast directly into target vessels
What is the point of entry for arteriograms Why?
femoral artery in femoral triangle
can be readily accessed for catheterization and then pushed against the femur to induce clotting once the procedure is concluded
When does the femoral bifurcate into the deep femoral (profunda)
2 inches beyond the inguinal ligament
Which is the larger of the branches of the tibial artery? what does it give off
posterior tibial
fibular
What is the most frequent indication for studying veins
to determine presence of blood clots
venous thrombosis
Why is accurate assessment of the venous system essential?
clots can break up and pass to the lungs with sometime fatal consequences
What is the most common non invasive method for studying veins
Doppler ultrasound
For which area is the doppler ultrasound effective
effective in studying the veins from the lower external iliac system down to the popliteal area
some patients, the veins of the calf can also be seen
Why are dopler studies often all that is required for clot adequate care assesment, even with their limited area of effectiveness?
clots arising from popliteal and femoral veins are much more prone to break off and pass to the lungs than those in the calf
What are the superficial veins frequently used as
bypass vessels for coronaries and leg arteries
