Radiology of the Lower Limb

Anteroposterior View of the Hips

iliac crest

anterior superior
Iliac spine

ischial spine

anterior inferior
iliac spine
femoral head

fovea
superior pubic
ramus

femoral neck
greater
trochanter
intertrochanteric
crest

pubic
symphysis

lesser
trochanter

superior acetabular rim

ilium

ischium
pubis
ischial tuberosity
obturator foramen

inferior pubic ramus

femoral shaft

Femoral Arteriogram

urinary
bladder

abdominal aorta

lumbar aa.

common iliac a.
internal iliac a.
external iliac a.
superior
gluteal a.
lateral
circumflex
femoral a.

inferior
gluteal a.

deep
femoral a.

superficial
femoral a.

ascending
branch

Whats Wrong With This Hip?

Avulsion fracture of anterior superior iliac spine

*hint*

Bonus: which muscle is responsible?

Sartorius

CT Imaging of the Hips: Axial View

acetabulum

anterior

greater trochanter
femoral head

coccyx

posterior

Whats Wrong With This Hip? (part 1)

not normal

normal

*hint*

Whats Wrong With This Hip? (part 2)

Axial CT Scan
not normal
normal

*hint*

Fractured acetabulum

A-P View of
the Knee

femur

patella

lateral epicondyle

medial epicondyle

intercondylar
eminences

fibular head

proximal tibial physis

(growth plate)

fibular neck
fibula

tibia

lateral femoral
condyle

medial femoral condyle

lateral tibial plateau

medial tibial plateau

Lateral View of the Knee

femur

intercondylar fossa
lateral femoral condyle
patella
fabella

medial femoral
condyle

fibular head

tibial tuberosity
fibula
tibia

Skyline View of the Knee

patella
medial femoral
condyle
lateral femoral
condyle

Arteriogram of the Knee

popliteal artery

anterior tibial artery

posterior tibial artery
common fibular a.

Whats Wrong With This Knee? (part 1)

normal

Whats Wrong With This Knee? (part 2)

normal

Dislocated patella

The Benefits of MRI

The ideal modality for imaging

soft tissues

Magnetic Resonance Imaging of the Knee: Saggital Plane

quadriceps
tendon

patella
femur

femur
posterior
cruciate lig.

tibia
tibia

intercondylar
eminence

popliteal artery

quadriceps
tendon

femur

femur

anterior cruciate
ligament

tibia
patellar ligament
tibia

lateral meniscus

MR Imaging of the Knee: Coronal Plane

medial

lateral

posterior cruciate
ligament

femur

anterior cruciate lig.

medial collateral
ligament

medial meniscus
tibia
lateral meniscus

medial

lateral

vastus lateralis
quadriceps muscle
(vastus medialis)

iliotibial band

femur
medial collateral lig.

tibia

Whats Wrong With This Knee?

Saggital MR images

normal

Patellar ligament rupture

A-P View of the Leg and Ankle

tibia

fibula

location of interosseus
membrane

ankle joint
inferior tibiofibular joint

medial malleolus
lateral malleolus
talus

Mortice View of the

Leg and Ankle

10 degrees internal rotation of ankle

Lateral View of the Leg and Ankle

fibula
tibia

medial malleolus
lateral malleolus
sustentaculum tali
talus
navicular
calcaneus

subtalar joint

Whats Wrong With This Leg?

normal

Avulsion fracture of medial

malleolus

But thats not all

What Else is Wrong With This Leg?

Maisonneuve fracture
External rotation
force to the ankle
causes an
avulsion of
the medial
malleolus

The force is
transmitted
through the
interosseus
membrane and
exits, causing a
fracture of the
proximal fibula

MR Imaging of the Ankle: Saggital Plane

flexor hallucis
longus
(muscle & tendon)

tibialis anterior
(tendon)
tibia

fat pad

navicular

talus
talocalcaneal
ligament

Achilles tendon
tarsal sinus

calcaneus

plantar
aponeurosis

tuberosity
of
calcaneus

flexor hallucis
longus

short saphenous
vein
tibia
sustentaculum
tali
talus

medial
cuneiform

tendon of
flexor hallucis
longus

MR Imaging of the Ankle: Coronal Plane

lateral

medial

tibia
medial malleolus
lateral
malleolus

flexor retinaculum
talus
fl. digitorum
longus (tendon)
sustentaculum
tali

calcaneus

abductor hallucis
flexor digitorum brevis

Lateral View of the Foot

neck of talus
talus
first metatarsal
navicular
phalanges

cuboid
calcaneus

tibia
subtalar joint
cuneiform (medial)

sustentaculum tali
styloid process (base) of fifth metatarsal

Dorsiplantar View of the Foot

1st distal phalanx
1
2
3
4
5

metatarsals

4th middle phalanx

5th proximal phalanx

cuneiform (medial)
talus
navicular

proximal phalanx (1st)

sesamoid bones

cuneiform (lateral)
cuboid
styloid process of 5th metatarsal
calcaneus

tarsometatarsal (Lisfrancs) joints

intertarsal (Choparts) joint

Arteriogram of the Foot

posterior tibial a.

lateral plantar a.

dorsalis pedis

anterior
tibial a.

Whats Wrong With This Foot? (part 1)

normal

*hint*

Whats Wrong With This Foot? (part 2)

*hint*

normal

Avulsion fracture of base of

5th metatarsal
Caused by which muscle?
Peroneus brevis

Additional Material

?
?

?
?

?
?

?
?

?
?
?
?
?
?
?

?
?

?
?

?
?

?
?

?
?

Whats Wrong With This Hip?

not
normal

normal

Congenital Dislocation of the hip

Whats Wrong With These Hips? (part 1)

and whats going
on here?

Whats Wrong With These Hips? (part 2)

Congenitally dislocated hips (in a child)

Whats Wrong With This Hip? (part 1)

A 47 year old male with a history of corticosteroid use
presents with hip pain

not normal

normal

One More Piece of the Puzzle A Technetium Bone Scan

Phosphate compounds
labelled with radioactive
99Tc are injected into
the patient
The labelled compounds
are deposited in bone
Areas of bone with
increased turnover show
up as hot spots (spots
of greater density) on the
scan
In this patient, the right
femoral head is hot while
the left femoral head is not.
Which begs the question,
Why?

hot

not

A Coronal MR Throws Some More Light on the Subject

not normal

Avascular necrosis of the femoral head

normal

Whats Wrong With This Knee?

A 30 year-old male presents
with knee pain. Significant
medical history includes a
skiing injury one year ago.

*hint*

normal

Whats Wrong With This Knee?

Perhaps a coronal MR
can help

A thickened MCL with

partial ossification

normal

*hint*

Whats Wrong With This Knee?

Saggital MR images

normal

Torn ACL

*hint*

Whats Wrong With This Leg?

Hmmm
This ones
tricky

Whats Wrong With This Foot? (part 1)

Hint:
the patient
is diabetic

And whats
this?

normal

Whats Wrong With This Foot? (part 2)

Gas gangrene with some

vascular calcification

Whats Wrong With This Ankle? (part 1)

*hint*

Whats Wrong With This Ankle? (part 2)

normal

Fracture of the talus

Whats Wrong With This Ankle?

Look
closely!

Ankle joint
effusion

normal

Whats Wrong With This Foot?

*hint*
normal

Heel spur