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