Describe your findings?
A needle targets the lateral femoral neck with its needle tip in the region of the lateral and mid femoral neck. Iodinated contrast extends in a striated orientation on the lateral aspect of the femoral neck without extension into the medial aspect. Findings due to an extra-articular needle tip position.
What would you do next?
Reposition the needle and use further injection(s) of contrast to confirm an intra-articular position.
Repositioning the needle does not work, what next?
There are a few options and they include using a new needle, using a needle technique (oblique), using a new target point and/or getting senior help.
A 22-gauge Quincke needle targets the lateral aspect of the femoral neck. Iodinated contrast has been injected and remains on the lateral aspect of the femoral neck in a linear fashion without extension into the medial aspect. Findings are due to an extra-articular needle tip position with contrast spreading along the extra-articular soft tissues. The needle should be repositioned and then a further injection of contrast is required to confirm an intra-articular needle position.