Does the injection of iodinated contrast show the needle is in an intra-articular position?
Predominantly yes, most of the injected contrast extends around the head neck portion of the hip joint. A tiny amount extends from the needle in a linear and vertical orientation, indicating the needle is partly in the soft tissues.
What is different about the pattern of the spread of iodinated contrast and what does this likely indicate?
The outline of the hip joint does not have a smooth contour and iodinated contrast has a patchy and globular pattern which most likely indicates synovial hypertrophy/ synovitis. The fluoroscopy image show advances bone on bone arthritis in the weight-bearing superior aspect of the hip joint. Therefore it is felt the synovial changes are reactive to the degenerative disease as opposed to an inflammatory arthropathy.
Advanced bone on bone arthritis in the weight-bearing aspect of the hip with an acetabular geode.
A 22G 90mm Quincke needle targets the superolateral aspect of the femoral neck. Administration of iodinated contrast under fluoroscopy shows most of the injected contrast extends around the head neck portion of the joint. A tiny amount extends from the needle in a linear fashion in a vertical orientation indicating the needle is partly in the soft tissues.