Ultrasound of the abdominal wall and groin

High-resolution ultrasound of spigelian and groin hernias: a closer look at fascial architecture and aponeurotic passageways

From the clinical point of view, a proper diagnosis of spigelian, inguinal and femoral hernias may be relevant for orienting the patient's management, as these conditions carry a different risk of complications and require specific approaches and treatments. Imaging may play a significant role in the diagnostic work-up of patients with suspected abdominal hernias, as the identification and categorization of these conditions is often unfeasible on clinical ground. Ultrasound imaging is particularly suited for this purpose, owing to its dynamic capabilities, high accuracy, low cost and wide availability. The main limitation of this technique consists of its intrinsic operator dependency, which tends to be higher in difficult-to-scan areas such as the groin because of its intrinsic anatomic complexity. An in-depth knowledge of the anatomy of the lower abdominal wall is, therefore, an essential prerequisite to perform a targeted ultrasound examination and discriminate among different types of regional hernias. The aim of this review is to provide a detailed analysis of the fascial architecture and aponeurotic passageways of the abdominal wall through which spigelian, inguinal and femoral hernias extrude, by means of schematic drawings, ultrasound images and video clips. A reasoned landmark-based ultrasound scanning technique is described to allow a prompt and reliable identification of these pathologic conditions.

Role of high-resolution ultrasound in the assessment of abdominal wall masses and mass-like lesions

Background

To evaluate the diagnostic accuracy of high-resolution ultrasound in the assessment of abdominal wall masses and mass-like lesions and to provide an overview of the sonographic appearances of different abdominal wall pathologies, 54 patients were included in a prospective study. The patients’ age was ranging from 1 to 75 years. Twenty-eight were females (51.9%) and 26 were males (48.1%); all were evaluated by a high-resolution ultrasound examination, and the results were correlated to the patients’ operative findings and histopathological results as well as the pelviabdominal CT findings.

Results

In comparison to the operative, histopathological, and CT findings, the high-resolution ultrasound had an overall 100% accuracy for abdominal wall lesions, and for hernia cases, it had 100% sensitivity, 100% specificity, 100% accuracy, 100% positive predictive value, and 100% negative predictive value.

Conclusion

The current study had encouraging results regarding the role of high-resolution ultrasound in the assessment of abdominal wall masses and mass-like lesions; nevertheless, it is considered as an effective and simple diagnostic tool that may limit the patients’ exposure to invasive biopsies and to the hazardous exposure to ionizing radiation and contrast media administration like that in CT examination.