Extra-articular hip arthrogram injection (fluroscopic guided)

Case contributed by Dr Dai Roberts

Presentation

For anesthetic arthrogram. Hip OA.

Patient Data

Age: 60
Gender: Male
Fluoroscopy

Injection of iodinated 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.  

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Case information

rID: 76496
Published: 3rd May 2020
Last edited: 8th May 2020
Inclusion in quiz mode: Included