Thomas Howard Grant DO, Abstract Co-Author: Nothing to Disclose

Erin Irene Neuschler MD, Presenter: Nothing to Disclose

Helena Gabriel MD, Abstract Co-Author: Nothing to Disclose

Wilson Hartz, III, Abstract Co-Author: Nothing to Disclose

Nathaniel Soper, Abstract Co-Author: Nothing to Disclose

Stephen Bradley Zivin MD, Abstract Co-Author: Nothing to Disclose

Inguinal hernias in women can be a cause of severe groin pain. They commonly mimic musculosketetal and gynecologic pathology, making them difficult to diagnose. These clinically complicated cases can be equally difficult to diagnose using CT or MR imaging. We present 17 cases of occult inguinal hernias in women detected with ultrasound. We describe the proper scanning technique, and report on the findings.

Seventeen women, ages 23 to 59 years old, were sent for ultrasound for the evaluation of a possible inguinal hernia. They all had indeterminate clinical presentations that defied definitive diagnosis. Patients were scanned using a standardized technique. A 12 MHz multi-frequency transducer was used in all cases. Images were stored on hard copy and with video clips. The inguinal ligament was localized after identifying the pubic tubercle and inferior epigastic artery. The exam was performed with and without the Valsalva maneuver in a supine position.

The majority of the women at clinical presentation had deep pelvic pain or groin “ache”. Two patients presented with a palpable mass. The ultrasound classification of the hernias was as follows: indirect (2), direct (11), femoral (2), hydrocele of the canal of Nuch (2). Eleven patients had surgical confirmation while the other six were treated conservatively with expectant elective surgery. Ultrasound findings included an unusually high percentage of direct hernias. Two patients with femoral hernias showed a paradoxical decrease in caliber of the common femoral vein, with Valsalva, presumably due to compression by the hernia.

Occult inguinal hernias in women may have unusual presentations that confound the clinical diagnosis. Ultrasound can be extremely helpful in their diagnosis when done with the proper technique. Our sonographic findings were atypical with a very high percentage of diagnosed direct hernias. This is likely related to the difficulty in detecting direct hernias clinically. In a woman, with groin pain and an indeterminate physical exam, we have found that dynamic ultrasound can accurately diagnose and classify inguinal hernias.

Grant, T, Neuschler, E, Gabriel, H, Hartz, III, W, Soper, N, Zivin, S, Ultrasound Diagnosis of Occult Inguinal Hernias in Women.  Radiological Society of North America 2005 Scientific Assembly and Annual Meeting, November 27 - December 2, 2005 ,Chicago IL. http://archive.rsna.org/2005/4418839.html