jenelle beadle 5/20/2015 inguinal/femoral. type based on location of defect contents fat,...

ABDOMINAL WALL ULTRASOUND

PROTOCOL

Jenelle Beadle5/20/2015

Inguinal/Femoral

Images Should Document:

Type Based on location of defect

Contents Fat, fluid, bowel

Movement through defect (valsalva) Reducibility (compression)

Completely reducible Partial reducible Non-reducible (incarcerated)

Size/Extent Diameter of neck/defect Inguinal hernias (e.g. extends into the scrotum)

Strangulated Hernias Incarcerated hernias can

result in bowel obstruction and/or stragulation Bowel involvement is a

surgical emergency Strangulation =

Ischemia Ultrasound Findings

Dilated, fluid filled bowel loops

Bowel wall thickening Non-peristalsing Free fluid within hernia sac

Groin Hernias

Inguinal Indirect Direct

Femoral

Inguinal Canal Entire canal is screened in short axis (w/

valsalva) Images are captured in long and short axis Transducer is oriented with the indicator as

shown below This can get confusing when in an oblique plane

Trans Rt Ing Canal Long Rt Ing Canal

Inguinal Canal Entire canal is screened in short axis (w/

valsalva) Images are captured in long and short axis Transducer is oriented with the indicator as

shown below This can get confusing when in an oblique plane

Trans Lt Ing Canal Long Lt Ing Canal

Proximal and Distal Inguinal Canal: Long and short axis Long and short axis w/ valsalva Long and short axis w/ valsalva cine

Scanning Protocol (normal)

Cine w/ Valsalva

• Long Inguinal Canal Prox

Cine w/ Valsalva

• Trans Inguinal Canal Prox

Cine w/ Valsalva

• Long Inguinal Canal Dist

Cine w/ Valsalva

• Trans Inguinal Canal Dist

Proximal and Distal Inguinal Canal: Long and short axis Long and short axis w/ valsalva Long and short axis w/ valsalva cine

Femoral Canal Short axis Short axis w/ valsalva Short axis w/ valsalva cine

Scanning Protocol (normal)

Cine w/ Valsalva

• Long Femoral

Cine w/ Valsalva

• Trans Femoral

Additional documentation will be necessary if a hernia is present. Documentation should describe the following:

Hernia type (based on origin) Contents (fat, fluid, bowel) Reducibility (with transducer compression) Extent (using sonographic landmarks)

The sonographer’s findings may read something like this: Fat-containing, indirect, right inguinal hernia.

Not completely reducible. With valsalva, it extends 1.5cm distal to the lateral pubic tubercle.

Scanning Protocol

Direct vs Indirect

Direct Medial Sagittal Canal side

wall

Indirect Lateral Oblique Deep inguinal

ring

Direct vs Indirect

Direct & Indirect Can extend through the

superficial inguinal ring and into the scrotum