Brian P. Jacob, David C. Chen, Bruce Ramshaw, Shirin Towfigh (eds.) - The SAGES Manual of Groin Pain-Springer International Publishing (2016)

7. Groin Pain Etiology: Athletic Pubalgia Evaluation…
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can enhance detection of the occult hernia [ 2 ]. Multiple published studies
from 1981 to the present show a sensitivity of 70–97 % for occult hernia.
The positive predictive value ranges from 90 to 95 % [ 3 – 5 ].
Computed tomography (CT) scan of the abdomen, to include the
pelvis, is another diagnostic imaging option used to detect occult hernia.
This modality is less operator dependent but has added cost and
radiation exposure to the patient. Though the patient is supine for this
test, a Valsalva maneuver during the scanning process can enhance hernia
detection. Figure 7.1 shows the cross-sectional image of an occult
bilateral inguinal hernia, the left being more obvious than the right.
Garvey et al. showed that in 158 patients with groin pain, no hernia on
exam, and then a subsequent CT scan, 54 patients (33 %) had evidence
of an occult inguinal hernia. At surgery, 49 were confirmed to have a
hernia, 3 had cord lipoma, and 2 had no inguinal pathology. This study
modality yields a positive predictive value of 92 %, a negative predictive
value of 96 %, and an overall accuracy of 94 % [ 6 ].
Fig. 7.1. Cross-sectional image of an occult bilateral inguinal hernia, left more
obvious than right.