Learning objectives
Illustrate the most common types of abdominal wall hernias.
Describe the proper dynamic ultrasound technique for evaluating anterior abdominal wall hernias.
Background
Abdominal wall hernias are often diagnosed clinically,
but those that present with pain without a lump or bulge are often referred for diagnostic imaging [1].
Real-time ultrasound has several advantages over other imaging modalities:
Accessible and relatively fast exam
It does not use ionizing radiation
The ability to scan the patient in both upright and supine positions
Use of dynamic manoeuvers
Ability to document motion in real time
Positioning and dynamic maneuvers affect the ability to diagnose a hernia,
alter its size and contents,
evaluate...
Findings and procedure details
US is a technique with known limitations and highly dependent on the operator expertise.
To accurately diagnose and give relevant information about an abdominal wall hernia,
the radiologist must be aware of some key aspects:
1 - KNOW YOUR ANATOMY:
An understanding of abdominal wall and inguinal region anatomy is essential to a accurate sonographic diagnosis.
The inferior epigastric artery (Fig.
2) at its origin is a critical anatomic landmark in differentiating indirect from direct inguinal hernias [1,5,6].
The inferior epigastric artery can usually be...
Conclusion
Dynamic ultrasound is the modality of choice for assessing abdominal wall pain,
enabling radiologists to more accurately detect hernias and evaluate their size,
contents,
reducibility,
and tenderness.
Each of these features should be determined during the examination and should be specifically mentioned in the final report,
along with the dynamic components of the examination.
References
Stavros,
A.
Thomas,
and Cindy Rapp.
“Dynamic Ultrasound of Hernias of the Groin and Anterior Abdominal Wall.” Ultrasound Quarterly,
vol.
26,
no.
3,
2010,
pp.
135–169.,
doi:10.1097/ruq.0b013e3181f0b23f.
Muysoms,
F.
E.
et al.
"Classification of primary and incisional abdominal wall hernias".
Hernia.
Springer.
2009.
407-414.
Available: 10.1007/s10029-009-0518-x
Jenkins,
John T and Patrick J O'Dwyer.
“Inguinal hernias” BMJ (Clinical research ed.) vol.
336,7638 (2008): 269-72.
AhmedAlenazi,
Abdulmajeed et al.
“Prevalence,
risk factors and character of abdominal hernia in Arar City,
Northern Saudi Arabia in 2017” Electronic physician...