sonography of herniasa74195b94871d463a2e2-d7df74e6cafe7f90aab9b1a3addada58.r88.… · significance...
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Sonography of Hernias
Cindy Rapp BS, RDMS, FAIUM, FSDMS
Sr. Clinical Marketing Manager
Toshiba America Medical Systems
Tustin, California
What is a hernia?
A hernia is a protrusion of an organ or tissue
through an abnormal opening in the body.
not all hernias contain bowel loops – fat is the
most common sonographic hernia content
Causes of hernias
Increase in the intra-abdominal pressure
obesity
chronic coughing
lifting heavy objects
straining
constipation
pregnancy
ascites
Sonography can determine…
location (type) of hernia
contents
reducibility (dynamic maneuvers)
strangulation
Sonography of Hernias
Abdominal Wall Hernias
inguinal hernia
•indirect
femoral hernia
spigelian hernia
68
7
6 = linea alba epigastric
7 = linea alba hypogastric
8 = incisional
Zarvan et al.
Sonography of Hernias
Hernia contents:
intraperitoneal
• fat
• fluid
• bowel
• vessels
• membranes
• incarceration
• bowel obstruction
• strangulation
Sonography of Hernias
Dynamic maneuvers
valsalva
compression
upright position
Indirect inguinal hernia
Valsalva
indirect inguinal herniacompression
dynamic maneuverupright
Fat containing hernia - Supine Fat and fluid - upright
Inguinal Hernia
Key to diagnosis of inguinal hernias
follow them to origin from EIA
inferior epigastric origin marks the
Internal Inguinal Ring
identify inferior epigastric vessels
key to identifying internal inguinal ring =
inferior epigastric vessels
4
long axis and short axis – not longitudinal and transverse
1
2
3
Inferior Epigastric Vessels
inguinal hernia
indirect
Inguinal Hernias
Indirect inguinal hernia
up and over (superficial) the inferior epigastric artery
anterior to the spermatic cord (round ligament)
may communicate with scrotum
indirect inguinal hernia
arises in the internal inguinal ring, superior, lateral, and passes anterior to the inferior epigastric artery
adapted from
Skandalakis et al.
indirect inguinal hernialong axis – up and over inferior epigastric vessels
A
indirect inguinal hernia
containing - fat and bowel
indirect inguinal herniashort axis
TRV RT ING CAN
A
trans left inguinal canal
indirect
indirect inguinal hernias
lie anterior to spermatic cord
compression of cord can cause pain radiating into scrotum
indirect inguinal hernia
indirect inguinal hernia extending into scrotum
femoral hernias
femoral hernia
femoral hernia
femoral hernia
femoral herniabilateral fat-containing
right femoral canal left femoral canal
spigelian hernias
spigelian hernia
adapted from
Skandalakis et al.
spigelian hernia
tear of transversus abdominus
sometimes internal oblique aponeurosis,
external oblique intact
Transv abd
Int obliq
Ext obliq
Rectus
left spigelian herniafat containing – partially reducible
left spigelian herniafat & bowel containing – partially reducible
Spigelian vs. indirect inguinal hernias
Mid line – Palpable ridge
Diastasis Recti
significance of incidence of multiple hernias
if a hernia detected on the symptomatic side:
look for additional hernias of other types (ipsilaterally)
look for mirror image hernias (contralaterally – some
types of hernias are frequently bilateral)
• femoral
• inguinal
• Spigelian
look for additional hernias aponeurosis
• epigastric hernias
How our report reads…
exam type, indications, and technique
exam: dynamic ultrasound of groin (Rt, Lt or Bilateral)
indication: right groin pain / lump
procedure: bilateral dynamic sonographic evaluation of the groin was
performed
with the patient in both supine and upright positions
with and without compression and Valsalva maneuvers
how a report reads:(primary findings)
There is a small… (size)
…right… (side)
…fat containing… (contents)
…non-reducible… (reducibility)
…indirect inguinal hernia… (type)
…that is...
tender when compressed. (tenderness)
The End