Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.

Ultrasound of the abdominal wall hernias

75,686 views

Published on

Published in: Health & Medicine, Business
  • DOWNLOAD THIS BOOKS INTO AVAILABLE FORMAT (Unlimited) ......................................................................................................................... ......................................................................................................................... Download Full PDF EBOOK here { https://tinyurl.com/y6a5rkg5 } ......................................................................................................................... Download Full EPUB Ebook here { https://tinyurl.com/y6a5rkg5 } ......................................................................................................................... ACCESS WEBSITE for All Ebooks ......................................................................................................................... Download Full PDF EBOOK here { https://tinyurl.com/y6a5rkg5 } ......................................................................................................................... Download EPUB Ebook here { https://tinyurl.com/y6a5rkg5 } ......................................................................................................................... Download doc Ebook here { https://tinyurl.com/y6a5rkg5 } ......................................................................................................................... ......................................................................................................................... ......................................................................................................................... .............. Browse by Genre Available eBooks ......................................................................................................................... Art, Biography, Business, Chick Lit, Children's, Christian, Classics, Comics, Contemporary, Cookbooks, Crime, Ebooks, Fantasy, Fiction, Graphic Novels, Historical Fiction, History, Horror, Humor And Comedy, Manga, Memoir, Music, Mystery, Non Fiction, Paranormal, Philosophy, Poetry, Psychology, Religion, Romance, Science, Science Fiction, Self Help, Suspense, Spirituality, Sports, Thriller, Travel, Young Adult,
       Reply 
    Are you sure you want to  Yes  No
    Your message goes here
  • People used to laugh at me behind my back before I was in shape or successful. Once I lost a lot of weight, I was so excited that I opened my own gym, and began helping others. I began to get quite a large following of students, and finally, I didn't catch someone laughing at me behind my back any longer. CLICK HERE NOW ➤➤ https://tinyurl.com/1minweight4u
       Reply 
    Are you sure you want to  Yes  No
    Your message goes here
  • Hello, doctor Haffar. Is it possible to download your nice presentation: "US of anterior abdominal wall hernias" - or - can you send it to my e-mail address: peterminarik57@gmail.com (?). Tnak you in advance. P. Minárik (Gastroenterologist, ultrasonographist).
       Reply 
    Are you sure you want to  Yes  No
    Your message goes here
  • pls give download link
       Reply 
    Are you sure you want to  Yes  No
    Your message goes here

Ultrasound of the abdominal wall hernias

  1. 1. US of anterior abdominal wall hernias Samir Haffar M.D. Assistant Professor of Gastroenterology
  2. 2. Anterior abdominal wall hernias • Types: Anterior abdominal wall hernias Incisional hernias • Pitfalls in hernia evaluation
  3. 3. Anterior abdominal wall hernias -1 Jamadar DA et al. AJR 2007; 188 : 1356 – 1364. Epigastric hernia Periumbilical hernia Umbilical hernia Infraumbilical divarication
  4. 4. Anterior abdominal wall hernias -2 Jamadar DA et al. AJR 2007; 188 : 1356 – 1364. Inferior epigastric artery & inguinal ligament Direct inguinal hernia Indirect inguinal hernia Femoral hernia Spigelian hernia
  5. 5. Incisional hernias Jamadar DA et al. AJR 2007; 188 : 1356 – 1364. Midline vertical incision Lower abdominal Pfannenstiel incision (bikini cut) Subcostal incision
  6. 6. Abdominal wall hernia  Epigastric hernia  Periumbilical hernia  Umbilical hernia  Infraumbilical divarication  Spigelian hernia  Indirect inguinal hernia  Direct inguinal hernia  Femoral hernia  Incisional hernia
  7. 7. Anterior abdominal wall hernias – 1 Jamadar DA et al. AJR 2007; 188 : 1356 – 1364. Epigastric hernia Periumbilical hernia Umbilical hernia Infraumbilical divarication
  8. 8.  Epigastric hernia
  9. 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
  10. 10.  Periumbilical hernia
  11. 11. Paraumbilical hernia Rectus abdominis muscle Rectus abdominis muscle Transverse sonogram Defect in linea alba Jamadar DA et al. AJR 2007; 188 : 1356 – 1364. Herniated extraperitoneal fat
  12. 12.  Umbilical hernia
  13. 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
  14. 14.  Infraumbilical divarication
  15. 15. Infraumbilical divarication of rectus abdominis Pre-Valsalva sonogram Both rectus abdominus muscles closely approximated to midline Jamadar DA et al. AJR 2007; 188 : 1356 – 1364. Pre-Valsalva sonogram Separation of rectus abdominis muscles
  16. 16. Anterior abdominal wall hernias – 2 Jamadar DA et al. AJR 2007; 188 : 1356 – 1364. Direct inguinal hernia Indirect inguinal hernia Femoral hernia Inferior epigastric artery
  17. 17. Anterior abdominal wall hernias – 2 Jamadar DA et al. AJR 2007; 188 : 1356 – 1364. Inferior epigastric artery & inguinal ligament Direct inguinal hernia Indirect inguinal hernia Femoral hernia Spigelian hernia
  18. 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. 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
  20. 20.  Spigelian hernia
  21. 21. Right spigelian hernia Jamadar DA et al. AJR 2006; 187:185–190 Rectus abdominis M Lateral abdominal M Inferior epigastric artery Peritoneal fat stripe Post-Valsalva sonogram Rectus abdominis M Lateral abdominal M Peritoneal fat stripe Pre-Valsalva sonogram
  22. 22. Left spigelian hernia Transverse sonogram along linea semilunaris Jamadar DA et al. AJR 2007; 188 : 1356 – 1364. Bowel Rectus abdominis Flank muscle Extraperitoneal fat
  23. 23.  Indirect inguinal hernia
  24. 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. 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
  26. 26.  Direct inguinal hernia
  27. 27. Direct inguinal hernia Jamadar DA et al. AJR 2007; 188 : 1356 – 1364. Rt inguinal region – Parallel & cranial to inguinal ligament Inferior epigastric artery Pre-Valsalva maneuver Fat stripe Post-Valsalva maneuver Inferior epigastric artery
  28. 28.  Femoral hernia
  29. 29. Femoral hernia Superior pubic ramus Pre-Valsalva maneuver Superior pubic ramus Post-Valsalva maneuver Jamadar DA et al. AJR 2007; 188 : 1356 – 1364. Rt inguinal region – Parallel & caudad to inguinal ligament
  30. 30. Incisional hernias Jamadar DA et al. AJR 2007; 188 : 1356 – 1364. Midline vertical incision Lower abdominal Pfannenstiel incision (bikini cut) Subcostal incision
  31. 31.  Incisional hernia
  32. 32. Incisional hernia Jamadar DA et al. AJR 2007; 188 : 1356 – 1364. 39-year-old woman with right upper quadrant discomfort medial to cholecystectomy incision (hernia) (extraperitoneal fat) (posterior rectus abdominis) Transverse oblique sonogram
  33. 33. Pitfalls in hernia evaluation
  34. 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. 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. 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. 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. 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. 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
  40. 40. Wound abscess Jamadar DA et al. AJR 2007; 188 : 1356 – 1364. Longitudinal sonogram Tubular structure Hypoechoic contents Thick & irregular walls Wavy echogenic structure Abdominal wall mesh Prior incisional hernia repair
  41. 41. Subcutaneous endometrioma 34-year-old woman after caesarian section Ill-defined heterogeneous mass with indistinct margins & minimal vascularity superficial to rectus abdominis muscle Jamadar DA et al. AJR 2007 ; 188 : 1356 – 1364. Longitudinal sonogram over scar
  42. 42. Thank You

×