High-resolution ultrasound in the evaluation of the adult hip

Figures

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  Fig. 1.. Normal anterior joint recess. Graphic illustrations (A, B) showing the transducer position (A) and equivalent anatomy (B) for long-axis scanning of the anterior hip joint recess. Long-axis US image (C) is depicted. Double-headed arrows in B and C demonstrate measurement of the recess (US image shows a recess measuring 5 mm)

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  Fig. 2.. Normal iliopsoas myotendinous junction (MTJ) complex on US. Graphic illustration (A) showing normal transducer positions and equivalent short-axis oblique (B) and short-axis (C) US images (LFI – lateral iliacus muscle; MFI – medial iliacus muscle; PMT – psoas tendon; PMM – psoas major muscle; FA – femoral artery). Fig. 2 A is modified with permission from Flores et al.(3)

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  Fig. 3.. Normal iliopsoas tendon on US. Graphic illustration (A) and long-axis US image (B) show normal iliopsoas tendon (arrowheads) (LT – lesser trochanter with contour outlined in light blue). Fig. 3 A is modified with permission from Flores et al.(3)

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  Fig. 4.. Normal rectus femoris anatomy. Graphic illustration (A) showing normal transducer positions and equivalent long-axis US images of the direct head (arrowheads) (B) and indirect head (arrows) (C) origins (blue outline – direct head origin at the ASIS; yellow outline – indirect head origin at the acetabular ridge)

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  Fig. 5.. Normal US and MRI of the LFCN. Short-axis US image (A) and axial PD-weighted fat-suppressed MR image (B) at the level of the iliacus muscle show a normal LFCN (yellow dotted outline in A and arrow in B) medial to the innominate bone and superficial to the iliacus muscle (Gmin – gluteus minimus; SAR – sartorius, TFL – tensor fascia lata)

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  Fig. 6.. Joint effusion on US. Long-axis US image in an adult patient, with clinical concern for joint effusion, demonstrates joint fluid pooling in the anterior joint recess (arrows). The presence o fluid outlines the cartilage (arrowhead), making it more conspicuous (cartilage conspicuity sign)

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  Fig. 7.. THA pseudotumor in a 60-year-old female with left hip swelling. Screening US was requested and long-axis US image of the left hip (A) shows large fluid collection (*) with hyperemia on color Doppler interrogation at the anterior aspect of the left hip. Transverse CT image of the pelvis (B) was requested the next day, confirming the pseudotumor (*). Note the streak artifacts emanating from the hardware on the CT image, though the large size of the pseudotumor enabled easy visualization

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  Fig. 8.. Anterosuperior paralabral cyst in a 70-year-old female with left hip pain of 4 months’ duration. Long-axis US image at the level of the hip (A) shows a complex lesion (arrows) arising from the joint space. This was noncompressible on transducer pressure, raising the possibility of a paralabral cyst. Axial PD-weighted fat-suppressed MR image (B) confirms a paralabral cyst (arrows) associated with an underlying labral tear (arrowhead)

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  Fig. 9.. Iliopsoas avulsion in a 90-year-old female with suspected joint effusion. Long-axis US at the level of the femoral head (A) shows a curvilinear echogenic lesion with marked shadowing (arrowheads) at the level of the femoral head, raising the possibility of an avulsed fracture fragment likely related to the iliopsoas. Radiographs were requested. AP radiograph (B) confirmed an avulsed bony fragment (arrowhead) along with a frank pathologic fracture of the proximal femoral diaphysis

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  Fig. 10.. Iliopsoas bursal fluid in a 68-year-old female with right hip and groin pain, query labral tear. Long-axis (A) and short-axis (B) US images show a large fluid collection (*) deep to the femoral vessels. It appears to be compartmentalized on short-axis image related to a prominent band of tissue suspected to be either a septation, a bifid or slip of the psoas tendon (arrowheads in B). Axial PD-weighted fat-suppressed MR image (C) confirms the bursal fluid and the band of tissue (arrowhead in C), which was confirmed to be a bifid tendon on the rest of the axial MR images. A hip joint effusion is also noted

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  Fig. 11.. Graphic illustration showing normal transducer position for assessing the lateral hip. For evaluation of the gluteus tendons at the facets, the transducer can be swept anterior to posterior and vice-versa (doubleheaded curved arrow)

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  Fig. 12.. Normal facets. Graphic illustration (A), short-axis US image (B) and axial T1-weighted MR image (C) show normal facets. The anterior (yellow dotted outline) and lateral (light blue dotted outline) facets are demarcated by a sharp bony angulation (*) while the contour between the lateral and posterior (red dotted outline in B and C) curves more gently. The gluteus minimus tendon (arrowheads in B and C) attaches to the anterior facet, while the gluteus medius tendon (arrows in B and C) to the lateral and superoposterior facets. Intervening bursae are also shown (Gmed-t – gluteus medius tendon; Gmed- m – gluteus medius muscle; Gmin-t – gluteus minimus tendon; Gmin-m – gluteus minimus muscle; Gmax – gluteus maximus muscle; TB – trochanteric bursa; Gmed-b – subgluteus medius bursa; Gmin-b – subgluteus minimus bursa; Gmax – gluteus maximus muscle)