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MDCT of Abdominal Wall Hernias: Is There a Role for Valsalva's Maneuver?

¹ All authors: Department of Radiology, Duke University Medical Center, Box 3808, Durham, NC 27710.

View larger version (130K): [in a new window]   Fig. 1A. —84-year-old man with suspected ventral hernia after abdominal surgery. CT scan obtained with IV and oral contrast material at rest shows defect in anterior abdominal wall (arrows). No intraperitoneal contents herniate through defect. Second defect in muscular anterior abdominal wall is seen (arrowheads) just craniad to ileostomy. At rest, no intraperitoneal contents protrude through this defect.

View larger version (158K): [in a new window]   Fig. 1B. —84-year-old man with suspected ventral hernia after abdominal surgery. CT scan obtained during Valsalva's maneuver shows protrusion of colon through midline defect (arrows). In addition, small bowel protrudes (arrowheads) at peristomal defect.

View larger version (138K): [in a new window]   Fig. 2A. —40-year-old man with suspected abdominal wall hernia. CT scan obtained with IV and oral contrast material at rest shows deficiency of anterior abdominal wall (arrows) with protrusion of small bowel and omental fat. Horizontal line denotes transverse diameter of hernia aperture. Short vertical line denotes anteroposterior (AP) measurement of hernia sac; long vertical line denotes AP measurement of abdomen.

View larger version (149K): [in a new window]   Fig. 2B. —40-year-old man with suspected abdominal wall hernia. CT scan obtained during Valsalva's maneuver shows protrusion of mesenteric fat and additional small bowel into hernia sac (arrows). In addition, transverse diameter of hernia aperture is wider (horizontal line). Note increase in AP measurement of hernia sac (short vertical line) and AP diameter of abdomen (long vertical line) with Valsalva's maneuver.

View larger version (122K): [in a new window]   Fig. 3A. —35-year-old man with suspected ventral hernia. CT scan obtained at rest with IV and oral contrast material shows defect (arrows) in upper abdominal wall. Portion of colon protrudes through defect

View larger version (121K): [in a new window]   Fig. 3B. —35-year-old man with suspected ventral hernia. CT scan obtained during Valsalva's maneuver shows no change in appearance of hernia (arrows).

View larger version (156K): [in a new window]   Fig. 4A. —60-year-old woman after mesh placement for hernia repair. CT scan obtained at rest with IV and oral contrast material shows mesh (arrows) in anterior abdominal wall. No recurrent hernia is evident at rest.

View larger version (174K): [in a new window]   Fig. 4B. —60-year-old woman after mesh placement for hernia repair. CT scan obtained during Valsalva's maneuver shows herniation of portion of gas-filled small bowel (arrowheads) at left aspect of mesh (arrow). In this patient, recurrent hernia would have been overlooked unless Valsalva's maneuver scan had been obtained.

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