Diagnostic ultrasound ( PDFDrive )

CHAPTER 13 Dynamic Ultrasound of Hernias of the Groin and Anterior Abdominal Wall 499
• Hyperechoic fat (see Fig. 13.59)
• Isoechoic thickening of the normally thin and echogenic hernia
sac (Fig. 13.61, see Video 13.23)
• Fluid within the sac (see Fig. 13.61, Video 13.23)
• hickening of bowel wall in bowel-containing hernias
(Fig. 13.62)
FIG. 13.59 Linea Alba Strangulated Hernia. Long-axis extended–
ield-of-view sonogram shows strangulated hypogastric linea alba hernia.
The hallmark of strangulation is hyperechogenicity of the fat with the
hernia.
In most strangulated hernias, more than one of these gray-scale
indings are present, even when Doppler ultrasound demonstrates
normal low within the hernia contents. Care should be taken
in equating luid within the hernia sac with strangulation;
nonstrangulated hernias that contain intraperitoneal contents
can contain peritoneal luid, especially in female patients.
Entities That Simulate Groin Hernias
A wide spectrum of space-occupying lesions in the groin can
simulate hernias of the groin (Fig. 13.63). Cysts or hydroceles
of the inguinal canal can occur in both males and females. In
males these localized luid collections can occur when the segment
of the processus vaginalis peritonei within the inguinal canal
A
B
FIG. 13.60 Color and pulsed Doppler shows (A) arterial and (B) venous low in fat-containing inguinal hernia.
TABLE 13.2 Findings of Hernia Strangulation
Sonographic Finding
Percent Incarcerated
(N = 23)
Percent Not Incarcerated
(N = 126)
Contents of hernia
Fat only
Fat and bowel
Bowel only
Urinary bladder
n = 6
n = 4
n = 13
n = 54
n = 47
n = 16
n = 3
Free luid in the hernia sac 91% (21/23) 3% (4/126)
Bowel wall thickening in the hernia (≥4 mm) 88% (15/17) 0% (0/63)
Fluid in the herniated bowel loop 82% (14/17) 3% (2/63)
Dilated loops of bowel in abdomen 65% (11/17) 0 (0/63)
Absence of blood low in the hernia 22% (5/23) 25% (31/126)
Absence of peristalsis within hernia 76% (13/17) 38% (24/63)
Modiied from Rettenbacher T, Hollerweger A, Macheiner P, et al. Abdominal wall hernias: cross-sectional imaging signs of incarceration
determined with sonography. AJR Am J Roentgenol. 2001;177(5):1061-1066. 34