How would you position the patient for the procedure?
Supine with a small bolster under the knee and a bolster keeping the foot internally rotated.
Describe your findings
The first image shows a needle inserted using an 'eye of the needle' approach and it targets the lateral femoral neck. The subsequent image has been taken after iodinated contrast has been injected and shows the spread in a linear fashion laterally but medially it distends the hip joint. Findings could be in keeping with a part intra- and part extra-articular needle tip position. Alternatively, the needle may have been repositioned after the initial injection which was extra-articular and after repositioning and further injection of contrast, the needle tip is now intra-articular.
What needle entry technique has been used?
An 'eye of the needle', technique which is parallel to the x-ray beam, perpendicular to the long axis of the patient.
What would you do next?
Inject more iodinated contrast. The needle tip may be intra-articular so it should be first checked before repositioning the needle.
The first image shows a 22-gauge needle inserted using an 'eye of the needle' approach which is parallel to the x-ray beam and perpendicular to the long axis of the patient. It targets the lateral femoral neck. The subsequent image has been taken after iodinated contrast has been injected and shows a linear spread laterally but medially it distends the hip joint. Findings could be in keeping with a part intra- and part extra-articular needle tip position. Alternatively, the needle may have been repositioned after an initial extra-articular injection was extra-articular, and after needle repositioning, the tip is now intra-articular.