Radiology of the Lower Limb

Anteroposterior View of the Hips

 iliac crest

anterior superior
Iliac spine

anterior inferior
ischial spine
iliac spine

femoral head

fovea
femoral neck

greater
superior pubic
trochanter
ramus
intertrochanteric
crest
pubic
lesser
symphysis
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
inferior femoral a.
gluteal a.

ascending
deep branch
superficial
femoral a. femoral a.
What’s 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

anterior
acetabulum
greater trochanter
femoral head

coccyx
posterior
What’s Wrong With This Hip? (part 1)

not normal normal

*hint*
What’s 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
fibular head
condyle

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.
What’s Wrong With This Knee? (part 1)

normal
What’s 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

p p
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
What’s 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

What’s Wrong With This Leg?

normal

Avulsion fracture of medial

malleolus But that’s 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

tibialis anterior flexor hallucis

(tendon) longus
(muscle & tendon)

tibia

navicular fat pad

talus Achilles’ tendon

talocalcaneal
ligament tarsal sinus

calcaneus

tuberosity
of
plantar calcaneus
aponeurosis
 flexor hallucis
longus

short saphenous
vein
tibia

sustentaculum
tali
talus tendon of
flexor hallucis
longus
medial
cuneiform
MR Imaging of the Ankle: Coronal Plane

lateral medial

tibia
medial malleolus

lateral flexor retinaculum

malleolus talus

fl. digitorum
longus (tendon)

sustentaculum
calcaneus tali

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

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 (Lisfranc’s) joints

intertarsal (Chopart’s) joint

Arteriogram of the Foot

posterior tibial a. anterior

tibial a.

lateral plantar a.

dorsalis pedis
 What’s Wrong With This Foot? (part 1)

normal

*hint*
What’s Wrong With This Foot? (part 2)

*hint*
normal
Avulsion fracture of base of
5th metatarsal

Caused by which muscle?

Peroneus brevis
Additional Material
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What’s Wrong With This Hip?

normal not
normal

Congenital Dislocation of the hip

What’s Wrong With These Hips? (part 1)

and what’s going

on here…?
What’s Wrong With These Hips? (part 2)

Congenitally dislocated hips (in a child)

What’s 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 hot not

In this patient, the right

femoral head is “hot” while
the left femoral head is not.
Which begs the question,
“Why?”
A Coronal MR Throws Some More Light on the Subject

not normal normal

Avascular necrosis of the femoral head

What’s 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
What’s Wrong With This Knee?

Perhaps a coronal MR
can help…

A thickened MCL with

partial ossification

normal

*hint*
What’s Wrong With This Knee?
Saggital MR images

normal

*hint*
Torn ACL
What’s Wrong With This Leg?

Hmmm…
This one’s
tricky
What’s Wrong With This Foot? (part 1)

Hint: normal
the patient
is diabetic

And what’s
this?
What’s Wrong With This Foot? (part 2)

Gas gangrene with some

vascular calcification
What’s Wrong With This Ankle? (part 1)

*hint*
What’s Wrong With This Ankle? (part 2)

normal

Fracture of the talus

What’s Wrong With This Ankle?
Look
closely!
Ankle joint
effusion

normal
What’s Wrong With This Foot?

*hint*

normal

Heel spur