AJR
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

This Article
Right arrow Abstract Freely available
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Jamadar, D. A.
Right arrow Articles by Franz, M. G.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Jamadar, D. A.
Right arrow Articles by Franz, M. G.
Social Bookmarking
Add to CiteULike   Add to Complore   Add to Connotea   Add to Del.icio.us   Add to Digg   Add to Reddit   Add to Technorati  
What's this?

Characteristic Locations of Inguinal Region and Anterior Abdominal Wall Hernias: Sonographic Appearances and Identification of Clinical Pitfalls

David A. Jamadar1, Jon A. Jacobson1, Yoav Morag1, Gandikota Girish1, Qian Dong1, Mahmoud Al-Hawary1 and Michael G. Franz2

1 Department of Radiology, TC2910, University of Michigan Hospitals, 1500 E Medical Center Dr., Ann Arbor, MI 48109.
2 Department of General Surgery, University of Michigan Hospitals, Ann Arbor, MI 48109.


Figure 1
View larger version (111K):
[in this window]
[in a new window]
[as a PowerPoint slide]
  		Fig. 1 —Illustration of anterior abdominal wall shows usual anatomic location of various anterior abdominal wall hernias. Red line in right lower quadrant indicates inferior epigastric artery. E = epigastric hernia; P = periumbilical hernia; U = umbilical hernia; Div = infraumbilical divarication of the rectus abdominis muscles, which may be seen along entire extent of linea alba; S = spigelian hernia; I = indirect inguinal hernia; D = direct inguinal hernia; F = femoral hernia.

 

Figure 2
View larger version (112K):
[in this window]
[in a new window]
[as a PowerPoint slide]
  		Fig. 2 —Illustration of anterior abdominal wall shows three surgical incisions, two in which skin incision may not accurately reflect incision through deeper tissues. Lower abdominal Pfannenstiel incision (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). Subcostal skin incision (B) is often shorter than deeper incision with extension along line of incision both medially and laterally. There is potential for hernia (ovals). Third, midline vertical incision (C) shows suture perforations (circles) on either side, a site for incisional hernias (curved arrow).

 

Figure 3
View larger version (100K):
[in this window]
[in a new window]
[as a PowerPoint slide]
  		Fig. 3 —55-year-old man with clinically diagnosed right groin hernia. Sonography cranial and parallel to inguinal ligament revealed indirect inguinal hernia adjacent to appendectomy scar (not shown). Preoperative diagnosis modified surgical approach. Sonogram after Valsalva maneuver shows hernia (H) and inferior epigastric artery (arrow). Right side of image is medial side of structures on sonogram.

 

Figure 4
View larger version (90K):
[in this window]
[in a new window]
[as a PowerPoint slide]
  		Fig. 4 —40-year-old woman with right indirect inguinal hernia. In sonogram with scanning cranial and parallel to inguinal ligament, inferior epigastric artery (curved arrow) marks medial boundary of deep inguinal ring and neck of this hernia (H). Lateral boundary (straight arrow) is less clearly seen. Right side of image is medial side of structures on sonogram.

 

Figure 5
View larger version (112K):
[in this window]
[in a new window]
[as a PowerPoint slide]
  		Fig. 5A —41-year-old man with new inguinal and suprapubic fullness and direct inguinal hernia. Pre-Valsalva maneuver transverse oblique sonogram shows external iliac artery (A), inferior epigastric artery (curved arrow), superior pubic ramus (arrowheads), and echogenic superficial boundary of hernia (straight arrows) not clearly demarcated. V = femoral vein.

 

Figure 6
View larger version (109K):
[in this window]
[in a new window]
[as a PowerPoint slide]
  		Fig. 5B —41-year-old man with new inguinal and suprapubic fullness and direct inguinal hernia. Post-Valsalva maneuver transverse oblique sonogram shows echogenic boundary of hernia (straight arrows), which originates medial to inferior epigastric artery (curved arrow). A = external iliac artery.

 

Figure 7
View larger version (95K):
[in this window]
[in a new window]
[as a PowerPoint slide]
  		Fig. 6 —35-year-old man with right femoral hernia. Sonogram caudad and parallel to inguinal ligament shows femoral vein (arrows) distorted and displaced ventrally by retrovascular femoral hernia (H). Femoral artery (A) is lateral in relation to hernia.

 

Figure 8
View larger version (110K):
[in this window]
[in a new window]
[as a PowerPoint slide]
  		Fig. 7 —41-year-old woman with left spigelian hernia. Transverse sonogram along linea semilunaris shows lateral border of rectus abdominis (R) and flank muscles (F) and between them, bowel (B) and extraperitoneal fat (EF) of hernia.

 

Figure 9
View larger version (116K):
[in this window]
[in a new window]
[as a PowerPoint slide]
  		Fig. 8 —44-year-old woman with epigastric hernia. Longitudinal sonogram along linea alba shows defect (arrows) in linea alba through which extraperitoneal fat herniates. Hernia (H) shows no movement during Valsalva maneuver, which is not unusual for these hernias when small.

 

Figure 10
View larger version (85K):
[in this window]
[in a new window]
[as a PowerPoint slide]
  		Fig. 9 —4-month-old boy with umbilical hernia. Transverse sonogram at umbilicus shows both medial margins of rectus abdominis muscles (R), between which is umbilical hernia (H).

 

Figure 11
View larger version (121K):
[in this window]
[in a new window]
[as a PowerPoint slide]
  		Fig. 10 —69-year-old man with supraumbilical fullness and paraumbilical hernia. Transverse sonogram shows defect in linea alba through which extraperitoneal fat herniates (arrows). Rectus abdominis muscles (R) can be seen on either side of defect.

 

Figure 12
View larger version (111K):
[in this window]
[in a new window]
[as a PowerPoint slide]
  		Fig. 11A —35-year-old woman with infraumbilical divarication of rectus abdominis. Pre-Valsalva maneuver transverse sonogram shows both rectus abdominus muscles (R) closely approximated to midline. Arrowheads show medial extent of rectus abdominis muscles.

 

Figure 13
View larger version (103K):
[in this window]
[in a new window]
[as a PowerPoint slide]
  		Fig. 11B —35-year-old woman with infraumbilical divarication of rectus abdominis. Post-Valsalva maneuver transverse sonogram shows separation of rectus abdominis muscles (R). Arrowheads show medial extent of rectus abdominis muscles.

 

Figure 14
View larger version (140K):
[in this window]
[in a new window]
[as a PowerPoint slide]
  		Fig. 12 —39-year-old woman with right upper quadrant discomfort medial to cholecystectomy incision with incisional hernia (corresponds to medial right upper quadrant incisional hernia illustrated in Fig. 2). Transverse oblique sonogram shows extraperitoneal fat (F) and hernia (H) between posterior rectus abdominis (R) and adjacent fascia defect (arrows). This unusual hernia was not appreciated at laparoscopy, and repeat open surgery was performed to repair hernia, with resolution of symptoms.

 

Figure 15
View larger version (126K):
[in this window]
[in a new window]
[as a PowerPoint slide]
  		Fig. 13A —69-year-old woman with complicated bilateral transverse rectus abdominis myocutaneous flap surgeries and absence of both rectus abdominis muscles who presented with palpable left upper quadrant mass for exclusion of incarcerated hernia. Sonograms show palpable abnormality secondary to abdominal wall atrophy. No hernia is seen. Oblique sonogram shows spleen (S), which is palpable and simulates mass. K = kidney.

 

Figure 16
View larger version (117K):
[in this window]
[in a new window]
[as a PowerPoint slide]
  		Fig. 13B —69-year-old woman with complicated bilateral transverse rectus abdominis myocutaneous flap surgeries and absence of both rectus abdominis muscles who presented with palpable left upper quadrant mass for exclusion of incarcerated hernia. Sonograms show palpable abnormality secondary to abdominal wall atrophy. No hernia is seen. Very thin anterior abdominal wall is better appreciated by close proximity of underlying bowel (B). Note centimeter scale to right of image.

 

Figure 17
View larger version (116K):
[in this window]
[in a new window]
[as a PowerPoint slide]
  		Fig. 14A —27-year-old woman with history of transient painful swelling in right epigastrium and muscle bulge from focal spasm. Pre-Valsalva maneuver longitudinal sonogram shows right proximal rectus abdominis muscle (arrows) directly under focal discomfort.

 

Figure 18
View larger version (113K):
[in this window]
[in a new window]
[as a PowerPoint slide]
  		Fig. 14B —27-year-old woman with history of transient painful swelling in right epigastrium and muscle bulge from focal spasm. Post-Valsalva maneuver longitudinal sonogram in same location as A shows right proximal rectus abdominis muscle bulging focally (arrows), clinically simulating hernia.

 

Figure 19
View larger version (93K):
[in this window]
[in a new window]
[as a PowerPoint slide]
  		Fig. 15A —42-year-old man with focal discomfort and bulge adjacent to right paramedian appendectomy scar, presumed secondary to postsurgical tissue scarring. Longitudinal sonogram over right rectus abdominis muscle (M) shows focal hyperechoic scar (S) at location of patient discomfort.

 

Figure 20
View larger version (96K):
[in this window]
[in a new window]
[as a PowerPoint slide]
  		Fig. 15B —42-year-old man with focal discomfort and bulge adjacent to right paramedian appendectomy scar, presumed secondary to postsurgical tissue scarring. Transverse sonogram shows rectus abdominis muscle (M) and focal hyperechoic scar (S).

 

Figure 21
View larger version (90K):
[in this window]
[in a new window]
[as a PowerPoint slide]
  		Fig. 16 —49-year-old man with prominent xiphoid process. Sagittal midline epigastric sonogram shows hypoechoic cartilaginous xiphoid process (X), which has ventral curve. Tip (arrow) is closest to overlying skin and under palpable abnormality.

 

Figure 22
View larger version (115K):
[in this window]
[in a new window]
[as a PowerPoint slide]
  		Fig. 17 —25-year-old woman with right inguinal lymph nodes. Sonogram caudad and parallel to inguinal ligament shows lymph node (arrows), with fatty hilum (Hi) medial to femoral artery (A) and femoral vein (V).

 

Figure 23
View larger version (126K):
[in this window]
[in a new window]
[as a PowerPoint slide]
  		Fig. 18 —53-year-old woman with left saphenous varix. Sonogram over proximal long saphenous vein shows focal variceal dilation (V) along proximal long saphenous vein (VV) just before it traverses cribriform fascia to anastomose with femoral vein (F).

 

Figure 24
View larger version (111K):
[in this window]
[in a new window]
[as a PowerPoint slide]
  		Fig. 19 —25-year-old woman with right groin hematoma. Transverse sonogram shows heterogeneous, predominantly hypoechoic mass (Hem) in superficial tissues.

 

Figure 25
View larger version (95K):
[in this window]
[in a new window]
[as a PowerPoint slide]
  		Fig. 20 —50-year-old woman with wound abscess. Longitudinal sonogram shows tubular structure with hypoechoic contents (A) with thick and irregular walls (curved arrows) of wound abscess. Wavy echogenic structure (straight arrows) deep in relation to abscess is abdominal wall mesh from prior midline vertical incisional hernia repair.

 

Figure 26
View larger version (114K):
[in this window]
[in a new window]
[as a PowerPoint slide]
  		Fig. 21 —34-year-old woman after caesarian section with subcutaneous endometrioma. Longitudinal sonogram over scar shows ill-defined heterogeneous mass with indistinct margins and minimal vascularity of endometrioma (E) superficial to rectus abdominis muscle (R).

 

Add to CiteULike CiteULike   Add to Complore Complore   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us   Add to Digg Digg   Add to Reddit Reddit   Add to Technorati Technorati    What's this?



HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
Copyright © 2007 by the American Roentgen Ray Society.