The document discusses ultrasound findings of thyroid nodules and abnormal cervical lymph nodes. It describes characteristics of abnormal lymph nodes seen on ultrasound including heterogeneous echotexture, calcifications, cystic areas, and size greater than 7mm. The majority of the document contains figures and captions describing ultrasound findings and techniques for evaluating hernias in the groin and abdominal wall, including indirect inguinal, direct inguinal, femoral, and Spigelian hernias. Landmarks like the inferior epigastric vessels are used to identify the inguinal canal and locations of different hernia types.

1. Ultrasound cases 9.24.13

2. Punctate echogenicities in thyroid nodules.
Frates M C et al. Radiology 2005;237:794-800
©2005 by Radiological Society of North America

3. Punctate echogenicities in thyroid nodules.
Frates M C et al. Radiology 2005;237:794-800
©2005 by Radiological Society of North America

4. Abnormal cervical lymph nodes.
Frates M C et al. Radiology 2005;237:794-800
©2005 by Radiological Society of North America

5. Abnormal cervical lymph nodes.
Frates M C et al. Radiology 2005;237:794-800
©2005 by Radiological Society of North America

8. Abnormal Neck Lymph Nodes
• Heterogeneous echotexture, calcifications, and cystic areas
• Round Lymph node
• Size is less reliable than shape or architecture
• Lymph nodes measuring > 7mm in short axis are suspicious

9. Inguinal hernias

11. Figure 2
FIGURE 2. A, Abdominal CT showing no
evidence of femoral hernias visualized. B,
Transverse image of the femoral canal during
quite respiration appearing normal. C,
Transverse image of the femoral canal during
Valsalva showing bilateral fat containing
hernias with the right being larger than the left
(arrows).
Copyright © 2013 Ultrasound Quarterly. Published by Lippincott Williams & Wilkins. 11
Dynamic Ultrasound of Hernias of the Groin and Ante
Stavros, A. Thomas; Rapp, Cindy
Ultrasound Quarterly. 26(3):135-169,
September 2010.
doi: 10.1097/RUQ.0b013e3181f0b23f
•

13. Figure 3
FIGURE 3. Long-axis image of an indirect
inguinal hernia (arrows) that contains only fat.
IEA indicates inferior epigastric artery.
Copyright © 2013 Ultrasound Quarterly. Published by Lippincott Williams & Wilkins. 13
Dynamic Ultrasound of Hernias of the Groin and Ante
Stavros, A. Thomas; Rapp, Cindy
Ultrasound Quarterly. 26(3):135-169,
September 2010.
doi: 10.1097/RUQ.0b013e3181f0b23f
•

15. Figure 4
FIGURE 4. Long-axis image of a fluid-
containing femoral hernia that presented with
pain and swelling.
Copyright © 2013 Ultrasound Quarterly. Published by Lippincott Williams & Wilkins. 15
Dynamic Ultrasound of Hernias of the Groin and Ante
Stavros, A. Thomas; Rapp, Cindy
Ultrasound Quarterly. 26(3):135-169,
September 2010.
doi: 10.1097/RUQ.0b013e3181f0b23f
•

17. Figure 5
FIGURE 5. Short-axis view of the inguinal
canal in the upright position showing an
indirect inguinal hernia that contains bowel.
Copyright © 2013 Ultrasound Quarterly. Published by Lippincott Williams & Wilkins. 17
Dynamic Ultrasound of Hernias of the Groin and Ante
Stavros, A. Thomas; Rapp, Cindy
Ultrasound Quarterly. 26(3):135-169,
September 2010.
doi: 10.1097/RUQ.0b013e3181f0b23f
•

19. Figure 6
FIGURE 6. Split-screen long-axis views of a
fat-containing indirect inguinal hernia during
quiet respiration and Valsalva maneuvers. The
left image shows the hernia during quiet
respiration (arrows). The right image, obtained
during a Valsalva maneuver, shows the hernia
contents being forced distally in a horizontal
direction within the inguinal canal (arrows and
dotted arrows).
Copyright © 2013 Ultrasound Quarterly. Published by Lippincott Williams & Wilkins. 19
Dynamic Ultrasound of Hernias of the Groin and Ante
Stavros, A. Thomas; Rapp, Cindy
Ultrasound Quarterly. 26(3):135-169,
September 2010.
doi: 10.1097/RUQ.0b013e3181f0b23f
•

21. Figure 7
FIGURE 7. Left image and diagram showing a
typical shape for direct inguinal hernia, a wide
neck in comparison to the fundus. This hernia
shape correlates with complete reducibility.
Right image and diagram show a typical shape
for a an linea alba hernia, a very narrow neck in
comparison to the fundal width. This hernia
shape correlates with nonreducibility and with
an increased risk of strangulation.
Copyright © 2013 Ultrasound Quarterly. Published by Lippincott Williams & Wilkins. 21
Dynamic Ultrasound of Hernias of the Groin
and Anterior Abdominal Wall
Stavros, A. Thomas; Rapp, Cindy
Ultrasound Quarterly. 26(3):135-169,
September 2010.
doi: 10.1097/RUQ.0b013e3181f0b23f
•

23. Figure 8
FIGURE 8. A, Long-axis view of a moderate-
sized indirect inguinal hernia obtained in the
supine position during a Valsalva maneuver and
showing it to contain only fat. B, Long-axis
view of the same hernia obtained immediately
after the patient was placed in the upright
position. The hernia appears slightly larger than
it was in the previous image but still contains
only fat. C, Delayed imaging in the upright
position now showing that the hernia also
contains fluid. This proves that the hernia
contains intraperitoneal contents not just
preperitoneal contents.
Copyright © 2013 Ultrasound Quarterly. Published by Lippincott Williams & Wilkins. 23
Dynamic Ultrasound of Hernias of the Groin
and Anterior Abdominal Wall
Stavros, A. Thomas; Rapp, Cindy
Ultrasound Quarterly. 26(3):135-169,
September 2010.
doi: 10.1097/RUQ.0b013e3181f0b23f
•

25. Figure 9
FIGURE 9. Diagram and images of the main
landmark for evaluating the inguinal area, the
inferior epigastric vessels (EIVs). Image 1 is
obtained in a transverse plane about half-way
between the umbilicus and the pubic
symphysis. The inferior epigastric artery and its
paired veins lie along the midlateral posterior
surface of the rectus abdominis muscle. Image
2 is obtained several centimeters inferiorly, and
the EIVs lie more laterally. Image 3 is obtained
at a level where the IEVs (arrow) lie at the
edge of the rectus muscle. (This is the level at
which most spigelian hernias occur.) Image 4
shows that once the origin of the inferior
epigastric artery, the transducer should be
rotated into planes that are parallel and
perpendicular to the inguinal canal-long-axis
and short-axis views.
Copyright © 2013 Ultrasound Quarterly. Published by Lippincott Williams & Wilkins. 25
Dynamic Ultrasound of Hernias of the Groin
and Anterior Abdominal Wall
Stavros, A. Thomas; Rapp, Cindy
Ultrasound Quarterly. 26(3):135-169,
September 2010.
doi: 10.1097/RUQ.0b013e3181f0b23f
•

27. Figure 10
FIGURE 10. Abdominal and pelvic CT image,
reformatted in the coronal plane, illustrating
the locations of the 4 types of "groin" hernias.
Indirect inguinal hernias arise within the
internal or deep inguinal ring, which lies in the
crotch between the external iliac artery and the
proximal inferior epigastric artery. Direct
inguinal hernias arise through the "conjoined
tendon," which lies inferior and medial to the
origin of the inferior epigastric artery.
Spigelian hernias arise through the spigelian
fascia just lateral to the inferior epigastric
artery where it reaches the lateral margin of the
rectus muscle. Femoral hernias lie within the
femoral canal, inferior to the inguinal canal and
inguinal ligament.
Copyright © 2013 Ultrasound Quarterly. Published by Lippincott Williams & Wilkins. 27
Dynamic Ultrasound of Hernias of the Groin
and Anterior Abdominal Wall
Stavros, A. Thomas; Rapp, Cindy
Ultrasound Quarterly. 26(3):135-169,
September 2010.
doi: 10.1097/RUQ.0b013e3181f0b23f
•