Premium
Role of Sonography in Clinically Occult Femoral Hernias
Author(s) -
Brandel David W.,
Girish Gandikota,
Brandon Catherine J.,
Dong Qian,
Yablon Corrie,
Jamadar David A.
Publication year - 2016
Publication title -
journal of ultrasound in medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.574
H-Index - 91
eISSN - 1550-9613
pISSN - 0278-4297
DOI - 10.7863/ultra.15.02061
Subject(s) - medicine , femoral hernia , femoral canal , groin , inguinal ligament , radiology , occult , surgery , inguinal canal , femoral vein , valsalva maneuver , hernia , inguinal hernia , total hip arthroplasty , alternative medicine , pathology , blood pressure
Objectives The purpose of this article is to evaluate the diagnostic accuracy of sonography in clinically occult femoral hernias and to describe our sonographic technique. Methods The clinical and imaging data for 93 outpatients referred by general surgeons, all of whom underwent sonographic evaluation and surgery, were reviewed retrospectively. Of these, 55 patients who underwent surgical exploration for groin hernias within 3 months of sonography and met all inclusion criteria were included in the study. The sonographic technique involves using the pubic tubercle as an osseous landmark to identify and appropriately visualize the femoral canal. The Valsalva maneuver is then used to differentiate the movement of normal fat (a potential pitfall) from true herniation in the femoral canal. Surgical findings were used as the reference standard by which sonographic results were judged. Two‐by‐two contingency tables were used to calculate the sensitivity, specificity, positive predictive value, and negative predictive value. Results In these 55 patients, surgery revealed 15 femoral hernias. Eight femoral hernias occurred in women, and 7 occurred in men. For diagnosing femoral hernias, sonography demonstrated sensitivity of 80%, specificity of 88%, a positive predictive value of 71%, and a negative predictive value of 92%. True‐positive cases of femoral hernias have a sonographic appearance of a hypoechoic sac with speckled internal echoes. When examining during the Valsalva maneuver, a femoral hernia passes deep to the inguinal ligament, expands the femoral canal, displacing the normal canal fat, and effaces the femoral vein. Conclusions Sonography can exclude femoral hernias with high confidence in light of its exceptional negative predictive value. With attention to technique and imaging criteria, the diagnostic accuracy of sonography can be enhanced.