Presentation
For anesthetic arthrogram. Hip OA.
Patient Data
Injection of contrast
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.
Case Discussion
One of the critical steps in fluoroscopic arthrogram injections is assessing the distribution of the iodinated contrast injection to assess if the needle is in an intra-articular position. It is important to know what a normal and expected spread of contrast into a joint, as once it is confirmed the next injectate is given - whether for MRI, CT or a steroid containing anesthetic arthrogram injectate.
Extra-articular injections often won't 'flow' easily like those in joint and extra-articular injections of iodinated contrast are striated and will not joint contour the joint. Shown is a classic example of an extra-articular injection with contrast spreading along the planes of the soft tissues.
Unable to process the form. Check for errors and try again.