Diagnostic ultrasound ( PDFDrive )

502 PART II Abdominal and Pelvic Sonography
A
B
C
D
FIG. 13.64 Entities That Simulate Anterior Abdominal Wall Hernia. (A) Muscle tear with hematoma. (B) Desmoid tumor. Anterior abdominal
wall desmoid tumor has a small amount of peripheral blood low. (C) Fibroma. Long-axis view of a benign ibroma of the anterior rectus sheath
of the inferior right rectus abdominis muscle that caused a nontender swelling near the right groin. Note that there is minimal internal vascularity.
(D) Fibrosarcoma. Transverse view of a ibrosarcoma of the anterior sheath of the left rectus abdominis muscle that manifested as a painless
lump. It is similar in appearance to the ibroma shown in (C) but is much more vascular.
examination include Valsalva and compression maneuvers and
scanning in both supine and upright positions. Dynamic sonography
enables clinicians to determine hernia type, size, contents,
reducibility, and tenderness.
Evaluation of groin pain in athletes is frequently more complex
than in nonathletes because of associated tendinosis and osteitis
pubis. Adding MRI to dynamic ultrasound is usually necessary
to identify underlying pathologic processes and decide the best
combination of surgical and nonsurgical treatments.
Patients with one hernia frequently have multiple hernias, so
in any patient in whom a hernia is sonographically demonstrable,
the examination should be continued, looking for other types
of ipsilateral and contralateral groin or anterior abdominal hernias.
Even when no additional hernias are found, it is important to
the surgeon to speciically mention in the report that a complete
search of both groin areas was made and no additional hernias
were found.
Strangulation is the most dreaded complication of groin
hernias. Gray-scale indings of strangulation—hyperechoic fat,
isoechoic thickening of the hernia sac, luid within the sac, and
thickening of the walls of bowel loops—are all more sensitive
for strangulation than is Doppler ultrasound.
Recurrent pain ater herniorrhaphy is a relatively common
problem. Dynamic sonography can be helpful in assessing both
acute and chronic recurrences of groin pain. Most hernia repairs
now use mesh. he key to sonographic identiication of recurrent
hernias is to assess the edges of the mesh with dynamic maneuvers,
because recurrent hernias arise from the edges of the mesh.
Many pathologic processes can simulate hernia, both rare
and nonspeciic, but cysts or hydroceles of the processus vaginalis
(or canal of Nuck) and round ligament varices are relatively
common and have virtually pathognomonic sonographic
appearances.
REFERENCES
1. Jacobson JA, Khoury V, Brandon CJ. Ultrasound of the groin: techniques,
pathology, and pitfalls. AJR Am J Roentgenol. 2015;205(3):513-523.
2. Rutkow IM. Demographic and socioeconomic aspects of hernia repair in
the United States in 2003. Surg Clin North Am. 2003;83(5):1045-1051,
v-vi.