Ultrasound Imaging of Hernia Parts 1 + 2 of 4 – A YouTube Video

The following video, Ultrasound Imaging of Hernia posted by 123radiology posted in 2015,  is approx 43 minutes long but worth it, I think.

The slides of Part 1 are from 0 to 8:50 and cover the pathology of abdominal hernias.

The slides of Part 2, from 8:50 to 22:30 and cover ultrasound exam techniques.

 

 

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Section 2 runs from 8:50 to

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Below are the four positions for abdominal hernia scanning:

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Below is the probe at position one:

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And below is what we see at position one:

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Position 1 is a good position for evaluating a Spigelian hernia* below:                                          *”A Spigelian hernia (or lateral ventral hernia) is a hernia through the spigelian fascia, which is the aponeurotic layer between the rectus abdominis muscle medially, and the semilunar line laterally.”

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From Position 1 we move to position two by following  the inferior epigastric vessels. And at position 2 we’re going to evaluate the inguinal canal:

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here is some stuff

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The Deep Inguinal Ring is lateral to Inferior Epigastric Vessels:

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If we move a little bit medial to position 3, we are looking at the area of the Hasselbach triangle. And this is where we look for direct inguinal hernia.

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Start here at 14:12

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Below is a schematic of the inguinal region. Fig a shows the deep inguinal ring lateral to inferior epigastric vessels. Fig b below shows a direct inguinal hernia medial to the inferior epigastric vessels. wFig c shows an indirect inguinal hernia arising from the deep inguinal ring medial to the inferior epigastric vessels.

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The direct hernia projects through the inguinal triangle. The indirect inguinal hernia  projects through the internal inguinal ring.

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We now move to area 4 to evaluate for femoral hernia below. And we have to move our probe inferiorly to the inguinal ligament:
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Again, we need to move the probe inferior to the inguinal ligament:

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Here is the oblique view below:

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The femoral hernia lies medial to the femoral vein and below the inguinal ligament below:

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Finally, we have an incisional hernia:

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