✔Well done to those of you who said it was a knee lipohaemarthrosis due to tibial plateau fracture!!
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📚Answer: On the lateral horizontal beam image a fat-fluid level is seen within the supra-patella joint recess consistent with a lipohaemarthrosis. This indicates that there must be an intra-articular fracture despite the fact that no fracture can be confidently identified on either the lateral or the AP image (case contributed by Dr Andrew Dixon).
💉What is a lipohaemarthrosis: They result from an intra-articular fracture with escape of fat and blood from the bone marrow into the joint, and is most frequently seen in the knee, associated with a tibial plateau fracture or distal femoral fracture; rarely a patellar fracture.
☢Techniques: Projections used are the AP non weight bearing and HBL.
•Anatomy viewed: Distal 3rd of femur, patella, femorotibial joint space, proximal tibia and fibula
•IR: 35 x 43 cm
•SID: 100 cm
•Centre point: 2.5 cm below the apex of the patella, through the joint space
•Collimation: Distal 3rd of femur, proximal 3rd of Tib/Fib, femoral condyles and skin/soft tissue margins.
•Average Exposure Factors: 60 Kv, 8 mAs •Comments: Patient is seated on the table with legs extended. The posterior aspect of the knee under examination is in contact with the IR. The leg is rotated to bring the tibial condyles equidistant to the IR.
🔎What to look for: It is well known that fat floats on water as it is less dense. The fatty marrow separates from the water-based blood and layers above it, forming a fat-fluid level. The fat-fluid level is seen on any horizontal beam radiograph, such that the beam is tangential to the fat-blood interface. In the knee this is best achieved with a cross-table horizontal lateral view, where a long horizontal line is seen in the suprapatellar pouch.
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