Diagnostic ultrasound ( PDFDrive )

CHAPTER 13 Dynamic Ultrasound of Hernias of the Groin and Anterior Abdominal Wall 481
Ind
FIG. 13.16 Indirect (Ind) Inguinal Hernia. (A) Drawing and (B) sonogram. Short-axis view shows indirect inguinal hernia displacing and
compressing the hyperechoic spermatic cord posteriorly.
SP CORD
Dir
HERNIA
FIG. 13.17 Direct (Dir) Inguinal Hernia. Short-axis view shows direct inguinal hernia displacing and compressing the hyperechoic spermatic
cord (SP CORD) anteriorly and laterally. See also Video 13.10.
hernias turn inferomedially, extending distally within the canal.
Factors associated with conjoined tendon insuiciency progression
to frank direct inguinal hernia include increased intraabdominal
pressure (obesity, pregnancy, ascites, coughing, straining) and
generalized connective tissue weakness. Because these underlying
causes afect both sides, direct inguinal hernias are frequently
bilateral, although oten asymmetric in size and symptoms (Fig.
13.25). Direct inguinal hernia and its precursor, posterior inguinal
wall insuiciency, are a common problem for athletes (see Sports
Hernias).
Femoral Hernias
he characteristic inding of a femoral hernia is abnormal
intraabdominal contents moving in an inferior direction through
the femoral canal. 1,8 Femoral hernias have been described as
having a sonographic appearance of a hypoechoic sac with
speckled internal echoes. When examining during the Valsalva
maneuver, a femoral hernia passes deep to the inguinal ligament,
expands the femoral canal, displacing the normal canal fat, and
efaces the femoral vein. 28
Femoral hernias are less common than inguinal hernias and
are diicult to diagnose clinically unless strangulated. Unlike
inguinal hernias, femoral hernias are more common in women
than in men. 8,24 Ultrasound has high accuracy (96.9%) for
diagnosis of nonpalpable femoral hernias in patients with
symptoms. 29 It is thought that the increased intrapelvic pressure
that occurs during the third trimester of pregnancy, together
with the hormone-induced sotening of tissues, predisposes to
the development of femoral hernias. hey are twice as common
on the right as on the let side. 30