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Valsalva's Maneuver in Abdominal Wall Hernia Imaging

Western Deep Levels Hospital Gauteng, South Africa

We read with great interest the article titled "MDCT of Abdominal Wall Hernias: Is There a Role for Valsalva's Maneuver?" written by Jaffe et al. [1]. After our experience with the value of including Valsalva's maneuver in the assessment of abdominal wall hernias on cross-sectional imaging [2], we hoped that researchers with access to greater numbers of patients would further definitively document the value of this technique. Although previously well described, it was our impression that the potential benefit of Valsalva's maneuver in this setting had been somewhat underappreciated. The authors are to be congratulated on a defining article on this subject.

Our original protocol included turning the patient to the left- or right-side-down decubitus position to add a gravitational effect to the Valsalva's maneuver to further stress the abdominal wall. We agree that in most cases the nonstraining series can be omitted. However, we differ with Jaffe et al. in that we do not believe it is necessary to give IV contrast in all cases. Omitting contrast further decreases cost and also eliminates the risk of contrast reaction.

With scanning protocols as invaluable guidelines, we see the variations in technique such as nonstraining series, decubitus series, and contrasted series as options available to assist in problem solving. From our perspective, the availability of these options reinforces the radiological maxim that our patients are best served when examinations are tailored to the needs of the individual.

What is abundantly clear from our experience and from the article by Jaffe et al. is that CT scanning is a highly sensitive technique for the assessment of anterior abdominal wall hernias and that the inclusion of a series taken while the patient performs Valsalva's maneuver is essential.

References

Top References

 

1. Jaffe TA, O'Connell MJ, Harris JP, Paulson EK, DeLong DM. MDCT of abdominal wall hernias: is there a role for Valsalva's maneuver? AJR 2005; 184:847 -851[Abstract/Free Full Text]
2. Emby DJ, Aoun G. CT technique for suspected anterior abdominal wall hernia. AJR 2003;181 : 431-433[Free Full Text]

Reply

Duke University Medical Center Durham, NC 27710

We thank Drs. Emby and Aoun for their interest in our article and their analysis of our technique. As a point of clarification, we do not insist that IV contrast be administered when evaluating abdominal wall hernias; the existing protocol with which the patients were scanned included both IV and oral contrast. We agree that tailoring a CT protocol to answer a specific clinical question is an important approach when evaluating patients with suspected abdominal hernias.

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This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Emby, D. J. Articles by Jaffe, T. Search for Related Content PubMed PubMed Citation Articles by Emby, D. J. Articles by Jaffe, T. Social Bookmarking                      What's this?