Lateral radiograph (A) of a 15-year-old boy shows a subperiosteal abscess that was aspirated and injected with contrast material. Anteroposterior (B) and lateral (C) radiographs of a 9-year-old child show contrast material in the subperiosteal area and within the medullary cavity after pus had been aspirated. The contrast material demonstrates the extent of the abscess.
Anterior (A) and posterior (B) roentgenograms of a sinogram in a 21-year-old man with chronic osteomyelitis that tracks into the intramedullary cavity.
What is sinogram?
It is a special X-ray procedure that is done with contrast dye to visualize any abnormal opening (sinus) in the body. The contrast is injected via a rubber catheter. Serial x-ray pictures are taken to show the extension of the fistula.
A low osmolar contrast medium, LOCM 150.
Technique :
Below are sequence of films taken to investigate a sinus at right mid thigh.
1. Prelim : shows intramedullary fixation of right femur fracture. Site of fistula is located at mid thigh.
2. Right thigh AP : Dye is injected. There is a focal collection of contrast seen.
3. Lateral view : shows focal collection of contrast.
4. Right lower thigh AP : shows seepage of contrast seen into the intramuscular layers of the lateral aspect of the right thigh.
5. Right upper thigh AP : shows seepage of contrast seen into the intramuscular layers of the lateral aspect of the right thigh up to the level of hip joint and distally to the level of distal femur (just above the femoral condyles).
NAME : ?
I/C : ?
SINOGRAM (01.04.2010)
Procedures:
Patient wound is cleaned. Sinus identified.
25 ml undiluted omipaque injected using 8F nasogastric tube.
Serial x-rays are taken.
Findings:
There is flow of contrast from the sinus into a focal collection measuring 3.5×4.5cm.
Seepage of contrast seen into the intramuscular layers of the lateral aspect of the right thigh.
Superiorly the contrast extends to the level of hip joint and distally to the level of distal femur (just above the femoral condyles).
There is no connection to the knee or hip joint.
CONCLUSION
No evidence of intra-articular extension of the right thigh abscess.
Radiologist 01.04.2010
Reference :
-The sagittal STIR (edema sensitive) MR image shows a thickened plantar fascia with edema. Contrast this with the thin fascia seen on the normal sagittal view.
Findings
Calcaneal fractures. Lateral ankle radiograph of 56-year-old woman with diabetes reveals avulsion fracture of calcaneal tuberosity.
Calcaneal fractures. Lateral ankle radiograph of 38-year-old woman who presented with ankle pain shows curvilinear sclerosis (arrows) exiting into superior aspect of calcaneus, consistent with stress fracture. Note subtle density in Kager's fat pad (asterisk).
32-year-old woman with Haglund's disease. Lateral ankle radiograph shows thickening of Achilles tendon at insertion (asterisk), retrocalcaneal bursitis (curved arrowhead), and retro-Achilles bursitis (double arrows). Triad of findings is consistent with Haglund's disease.
Abnormalities of Achilles tendon. Lateral ankle radiograph of 48-year-old man shows ossified Achilles tendon caused by previous tear.
Abnormalities of Achilles tendon. Sagittal spin-echo T1-weighted image of 42-year-old man shows large area of intermediate signal in expected location of Achilles tendon, flanked superiorly and inferiorly by irregular ends of ruptured and retracted Achilles tendon.
Abnormalities of Achilles tendon. Sagittal fat-suppressed fast spin-echo T2-weighted image of 26-year-old man shows focal hyperintensity in thickened Achilles tendon, corresponding to partial tear (arrowhead) of Achilles tendon, and edema (arrow) in Kager's fat pad.
Normal anatomy of Kager's fat pad. Lateral radiograph (A) and illustration (B) of ankle show triangular radiolucency (A) and structure of Kager's fat pad. On radiograph, anterior border (arrowheads, A) is posterior aspect of flexor hallucis longus muscle and tendon, posterior border (asterisk, A) is Achilles tendon, and floor (arrow, A) is superior surface of calcaneus.
Normal anatomy of Kager's fat pad. Lateral radiograph (A) and illustration (B) of ankle show triangular radiolucency (A) and structure of Kager's fat pad. On radiograph, anterior border (arrowheads, A) is posterior aspect of flexor hallucis longus muscle and tendon, posterior border (asterisk, A) is Achilles tendon, and floor (arrow, A) is superior surface of calcaneus.
Findings
Findings
The axial image demonstrates increased signal (arrow) within fat interposed between the lateral aspect of the patellar tendon and the lateral trochlear ridge. Mild lateral patellar subluxation is present as indicated by the off-midline positioning of the patellar tendon (arrowhead).
The sagittal image demonstrates increased signal (arrow) within the fat below the caudal margin of the patella as well as moderate patella alta (arrowhead). Note the high riding appearance of the patella.
Three normal anterior knee fat pads are present at the knee; the quadriceps (anterior suprapatellar) (red), the prefemoral (posterior suprapatellar or supratrochelar) (blue), and Hoffa (infrapatellar) (yellow) fat pads.
fat-suppressed proton density-weighted sagittal images in a basketball player who sustained an acute injury reveal marked edema about the patellar tendon with a fluid filled gap (arrows) at the central tendon, compatible with a complete rupture. The retracted proximal and distal ends (arrowheads) are markedly thickened, indicating severe tendinosis. The vast majority of patellar tendon ruptures occur in patients with pre-existing patellar tendinosis.
A proton density-weighted axial view demonstrates the normal semilunar appearance of the patellar tendon, with a convex anterior border (arrow) and well-defined posterior rim.
T1-weighted sagittal image in a patient with a normal patellar tendon reveals a homogeneously low signal intensity appearance to the tendon (arrows), which appears symmetrical in appearance throughout its course.
