9. Epigastric hernia
Jamadar DA et al. AJR 2007; 188 : 1356 – 1364.
Longitudinal sonogram along linea alba
No movement during Valsalva maneuver
Not unusual for these hernias when small
Defect in
linea alba
Herniated
extraperitoneal fat
13. Umbilical hernia
Jamadar DA et al. AJR 2007; 188 : 1356 – 1364.
4-month-old boy with umbilical hernia
Transverse sonogram at umbilicus
Umbilical hernia
Medial margin of
of rectus abdominis
Medial margin of
of rectus abdominis
18. Man’s right inguinal region
viewed from within abdomen
Jamadar DA et al. AJR 2006; 187:185–190
Inferior
epigatric artery
Rectus
abdominal
Inguinal
ligamentDeep ring
Vas deferens
Direct
inguinal hernia
Femoral hernia
Spigelian hernia
Indirect
inguinal hernia
19. Transducer position to evaluate
abdominal wall hernias
Jamadar DA et al. AJR 2006; 187:185–190
1- Spigelian hernia
4- Femoral hernia
3- Direct inguinal
hernia
2- Indirect inguinal
hernia
24. Normal inguinal anatomy
Jamadar DA et al. AJR 2007 ; 188 : 1356 – 1364.
Rt inguinal region – Parallel to & cranial to inguinal ligament
Superior pubic
ramus
25. Indirect inguinal hernia
Jamadar DA et al. AJR 2007; 188 : 1356 – 1364.
Rt inguinal region – Parallel & cranial to inguinal ligament
Pre-Valsalva maneuver
Superior
pubic ramus
Post-Valsalva maneuver
Superior
pubic ramus
34. Pitfalls in hernia evaluation
• Atrophy of anterior abdominal wall muscles
• Focal spasm in an abdominal wall muscle
• Xiphoid process noticeable after weight loss
• Enlarged lymph nodes
• Saphenous varix
• Hematoma
• Focal fluid collection
• Subcutaneous endometrioma
Jamadar DA et al. AJR 2007 ; 188 : 1356 – 1364.
35. Atrophy of anterior abdominal wall muscles
Jamadar DA et al. AJR 2007 ; 188 : 1356 – 1364.
Appreciated by close proximity of underlying bowel to abdominal wall
Centimeter scale to right of image
36. Prominent xiphoid process
Jamadar DA et al. AJR 2007 ; 188 : 1356 – 1364.
Sagittal midline epigastric sonogram
Hypoechoic cartilaginous xiphoid process (X) with ventral curve
Tip (arrow) closest to overlying skin & under palpable abnormality
37. Inguinal lymph nodes
Lymph node with fatty hilum
Medial to femoral artery (A) & femoral vein (V)
Jamadar DA et al. AJR 2007; 188 : 1356 – 1364.
Sonogram caudad & parallel to inguinal ligament
38. Saphenous varix
Jamadar DA et al. AJR 2007 ; 188 : 1356 – 1364.
Focal variceal dilation (V) along proximal LSV
Just before it traverses cribriform fascia to anastomose with FV
V
FV
LSV
Sonogram over proximal LSV
39. Groin hematoma
Jamadar DA et al. AJR 2007; 188 : 1356 – 1364.
25-year-old woman with right groin hematoma
Transverse sonogram
Heterogeneous, predominantly hypoechoic mass in superficial tissues
Subcostal incision skinincisionshorter than deeper incision with extension along line of incision both medially and laterally. There is potential for hernia (ovals).Midline vertical incisionSuture perforations (circles) site for incisional hernias (curved arrow).Lower abdominal Pfannenstiel incision (bikini cut)Bikini cut is curvilinear cutaneous and subcutaneous incision (A), but vertical component of incision is between rectus abdominis muscles, with potential for incisional hernia (vertical rectangle).
Sonogram of inguinal region parallel and cranial to inguinal ligament Spermatic cord (C), external iliac artery (A), inferior epigastric artery (E), femoral vein (V), and superior pubic ramus (curved arrow).
Pre-Valsalva maneuver sonogramHernia not visible, external iliac artery (A), inferior epigastric artery (E), and superior pubic ramus (curved arrow).Post-Valsalva maneuver sonogram External iliac artery (A), inferior epigastric artery (E), dilated external iliac vein (V), superior pubic ramus (curved arrow), and indirect inguinal hernia (H) originating from lateral to external iliac artery (arrowhead) and traversing inguinal canal from lateral to medial. (Left = lateral)
Pre-Valsalva maneuver sonogram Hernia not visible, peritoneal fat stripe (straight arrows) medial to inferior epigastric artery (curved arrow).Post-Valsalva maneuver sonogramDirect inguinal hernia deforming peritoneal reflection (straight arrows) medial to inferior epigastric artery (curved arrow). Left is lateral, right is medial.
Pre-Valsalva maneuver sonogram Hernia not visible, femoral artery (A), femoral vein (V), and superior pubic ramus (curved arrow).Post-Valsalva maneuver sonogram Dilated femoral vein (V) lateral to femoral hernia (arrows). Superior pubic ramus (curved arrow) is also seen.
Subcostal incision skinincisionshorter than deeper incision with extension along line of incision both medially and laterally. There is potential for hernia (ovals).Midline vertical incisionSuture perforations (circles) site for incisional hernias (curved arrow).Lower abdominal Pfannenstiel incision (bikini cut)Bikini cut is curvilinear cutaneous and subcutaneous incision (A), but vertical component of incision is between rectus abdominis muscles, with potential for incisional hernia (vertical rectangle).
