Diagnostic Ultrasound - Abdomen and Pelvis

Abdominal Wall Hernia
Diagnoses: Abdominal Wall/Peritoneal Cavity
TERMINOLOGY
• Hernia: Weakness or defect in fibromuscular wall with
protrusion of an organ or part of an organ through the
defect
IMAGING
• Midline hernias
○ Epigastric: Between xiphisternum and umbilicus
○ Umbilical: Umbilical or immediate paraumbilical region
○ Hypogastric: Between umbilicus and pubic symphysis
• Lateral hernias
○ Spigelian
○ Lumbar: Occur in 2 potentially weak areas of flank
• Incisional hernia: Located at surgical incisional site
• Complications: Incarceration, strangulation, bowel
obstruction
• Ultrasound first-line imaging for smaller hernias or children
○ Uniquely dynamic, real-time examination; repeatable,
widely available, inexpensive
KEY FACTS
○ Use of maneuvers such as Valsalva or standing position
to improve detection of hernias
• CT for larger deep-seated hernias and complications and
obese patients
• MR similar to CT but can use dynamic sequences during
Valsalva
TOP DIFFERENTIAL DIAGNOSES
• Abdominal wall tumor
• Abdominal wall abscess or seroma
• Abdominal wall or rectus sheath hematoma
• Divarication (diastasis) of rectus abdominis muscles
DIAGNOSTIC CHECKLIST
• Determine nature of herniated content (omentum, bowel),
site/size of abdominal wall defect
(Left) Graphic shows a
paraumbilical hernia
arising from the umbilicus
area. The locations of
epigastric , spigelian ſt,
and hypogastric hernias are
also shown for reference.
(Right) Clinical photograph
shows a typical appearance of
a small paraumbilical hernia in
an adult with swelling at
the superior aspect of the
umbilicus.
(Left) Longitudinal ultrasound
of a recurrent periumbilical
hernia in a young woman
following 2 pregnancies.
Omental fat protrudes
through a narrow defect st in
the linea alba accentuated by
the Valsalva maneuver. (Right)
Longitudinal color Doppler
ultrasound of the same
recurrent periumbilical hernia.
The linea alba is better seen as
a thin echogenic line ſt with a
small defect. No color flow is
seen in the herniated
omentum , not necessarily
indicative of strangulation as
fat is usually hypovascular.
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