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
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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
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Causes of hernias
Increase in the intra-abdominal pressure
obesity
chronic coughing
lifting heavy objects
straining
constipation
pregnancy
ascites
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Sonography can determine…
location (type) of hernia
contents
reducibility (dynamic maneuvers)
strangulation
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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.
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Sonography of Hernias
Hernia contents:
intraperitoneal
• fat
• fluid
• bowel
• vessels
• membranes
• incarceration
• bowel obstruction
• strangulation
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Sonography of Hernias
Dynamic maneuvers
valsalva
compression
upright position
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Indirect inguinal hernia
Valsalva
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indirect inguinal herniacompression
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dynamic maneuverupright
Fat containing hernia - Supine Fat and fluid - upright
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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
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key to identifying internal inguinal ring =
inferior epigastric vessels
4
long axis and short axis – not longitudinal and transverse
1
2
3
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Inferior Epigastric Vessels
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inguinal hernia
indirect
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Inguinal Hernias
Indirect inguinal hernia
up and over (superficial) the inferior epigastric artery
anterior to the spermatic cord (round ligament)
may communicate with scrotum
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indirect inguinal hernia
arises in the internal inguinal ring, superior, lateral, and passes anterior to the inferior epigastric artery
adapted from
Skandalakis et al.
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indirect inguinal hernialong axis – up and over inferior epigastric vessels
A
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indirect inguinal hernia
containing - fat and bowel
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indirect inguinal herniashort axis
TRV RT ING CAN
A
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trans left inguinal canal
indirect
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indirect inguinal hernias
lie anterior to spermatic cord
compression of cord can cause pain radiating into scrotum
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indirect inguinal hernia
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indirect inguinal hernia extending into scrotum
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femoral hernias
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femoral hernia
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femoral hernia
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femoral hernia
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femoral herniabilateral fat-containing
right femoral canal left femoral canal
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spigelian hernias
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spigelian hernia
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adapted from
Skandalakis et al.
spigelian hernia
tear of transversus abdominus
sometimes internal oblique aponeurosis,
external oblique intact
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Transv abd
Int obliq
Ext obliq
Rectus
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left spigelian herniafat containing – partially reducible
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left spigelian herniafat & bowel containing – partially reducible
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Spigelian vs. indirect inguinal hernias
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Mid line – Palpable ridge
Diastasis Recti
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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
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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
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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)
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The End