Diagnostic ultrasound ( PDFDrive )

484 PART II Abdominal and Pelvic Sonography
FIG. 13.24 Conjoined Tendon: Two More Views. Left image, Relationship of the conjoined tendon (arrows) to the spermatic cord (dashed
oval) in quiet respiration in the supine position. The conjoined tendon lies posterior to the spermatic cord. Right image, Valsalva maneuver results
in anterior bulging of the conjoined tendon, which now protrudes anterior to the spermatic cord and pushes and rotates the cord laterally.
FIG. 13.25 Bilateral Inguinal Hernias. Short-axis views show bilateral fat-containing direct inguinal hernias, which are common. Markings
are the same as in Fig. 13.24.
is always torn. In most cases the internal oblique aponeurosis
is also torn (Fig. 13.32). he external oblique tendon is always
intact and usually forces the hernia sac to extend either medially
over the anterior aspect of the rectus abdominis muscle or laterally
over the external oblique muscle, forcing it into the shape of an
anvil or mushroom (Figs. 13.33 and 13.34). As with femoral
hernias, spigelian hernias have narrow necks and broad fundi
(Video 13.11 and Video 13.12), making them at least partially
nonreducible and predisposing them to strangulation (Fig. 13.35).
Because spigelian hernias pass through multiple layers of tendons,
projections of the hernia may also extend intraparietally between
the multiple layers of lateral muscles (either between the transverse
abdominis and internal oblique muscles or between the internal
and external oblique muscles). In some cases the spigelian fascia,
like the linea alba, can become diastatic and widen. Extended-FOV
modes may be helpful in demonstrating the anatomy in such
cases (see Figs. 13.32 and 13.33). Sonography shows a complex
mass within the anterolateral aspect of the abdominal wall, which
may contain luid or gas-illed loops of bowel. 35
Sports Hernias
Sports hernia is a common cause of groin and pubic pain among
elite and professional athletes. In a review of chronic groin pain
in athletes, sports hernia was found in 50%. 36 Sports hernia, also