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ABDOMINAL WALL ULTRASOUND
PROTOCOL
Jenelle Beadle5/20/2015
Inguinal/Femoral
Images Should Document:
Type Based on location of defect
Contents Fat, fluid, bowel
Movement through defect (valsalva) Reducibility (compression)
Completely reducible Partial reducible Non-reducible (incarcerated)
Size/Extent Diameter of neck/defect Inguinal hernias (e.g. extends into the scrotum)
Strangulated Hernias Incarcerated hernias can
result in bowel obstruction and/or stragulation Bowel involvement is a
surgical emergency Strangulation =
Ischemia Ultrasound Findings
Dilated, fluid filled bowel loops
Bowel wall thickening Non-peristalsing Free fluid within hernia sac
Groin Hernias
Inguinal Indirect Direct
Femoral
Inguinal Canal Entire canal is screened in short axis (w/
valsalva) Images are captured in long and short axis Transducer is oriented with the indicator as
shown below This can get confusing when in an oblique plane
Trans Rt Ing Canal Long Rt Ing Canal
Inguinal Canal Entire canal is screened in short axis (w/
valsalva) Images are captured in long and short axis Transducer is oriented with the indicator as
shown below This can get confusing when in an oblique plane
Trans Lt Ing Canal Long Lt Ing Canal
Proximal and Distal Inguinal Canal: Long and short axis Long and short axis w/ valsalva Long and short axis w/ valsalva cine
Scanning Protocol (normal)
Cine w/ Valsalva
• Long Inguinal Canal Prox
Cine w/ Valsalva
• Trans Inguinal Canal Prox
Cine w/ Valsalva
• Long Inguinal Canal Dist
Cine w/ Valsalva
• Trans Inguinal Canal Dist
Proximal and Distal Inguinal Canal: Long and short axis Long and short axis w/ valsalva Long and short axis w/ valsalva cine
Femoral Canal Short axis Short axis w/ valsalva Short axis w/ valsalva cine
Scanning Protocol (normal)
Cine w/ Valsalva
• Long Femoral
Cine w/ Valsalva
• Trans Femoral
Additional documentation will be necessary if a hernia is present. Documentation should describe the following:
Hernia type (based on origin) Contents (fat, fluid, bowel) Reducibility (with transducer compression) Extent (using sonographic landmarks)
The sonographer’s findings may read something like this: Fat-containing, indirect, right inguinal hernia.
Not completely reducible. With valsalva, it extends 1.5cm distal to the lateral pubic tubercle.
Scanning Protocol
Direct vs Indirect
Direct Medial Sagittal Canal side
wall
Indirect Lateral Oblique Deep inguinal
ring
Direct vs Indirect
Direct & Indirect Can extend through the
superficial inguinal ring and into the scrotum