US medial hip and thigh Pitt Conference/US...¢  Sartorius Tear Inguinal Hernia Epidemiology ¢â‚¬¢!Most

  • View
    2

  • Download
    0

Embed Size (px)

Text of US medial hip and thigh Pitt Conference/US...¢  Sartorius Tear Inguinal Hernia...

  • 8/26/18

    1

    US of Medial Hip and Thigh

    Levon N. Nazarian, MD Professor of Radiology

    Thomas Jefferson University Hospital

    Disclosures

    •!None relevant to this presentation

    Educational Objective

    •! Following the presentation, participant should be able to: –!Discuss the role of US in imaging

    the medial hip and thigh –!Identify anterior and medial hip

    and thigh pathologies seen on US

    Disclosures

    •!None relevant to the presentation

    Iliopsoas

    www.essr.org

    Iliopsoas Tendinosis

  • 8/26/18

    2

    Iliopsoas Bursitis Iliopsoas Bursitis

    Iliopsoas Bursitis Normal Iliopsoas Motion

    Snapping Iliopsoas Tendon Snapping Iliopsoas Tendon: Harmonic Imaging

  • 8/26/18

    3

    Acute Thigh Hematoma: Etiology?

    EFOV Identifies Muscle as Sartorius

    Sartorius Tear Inguinal Hernia Epidemiology

    •! Most common hernia type •! More than 1 million hernias

    repaired each year in US: 75% are inguinal

    Identification of the inferior epigastric vessels is critical to

    localizing an inguinal hernia •! 1.

    Types of Inguinal Hernias

    •! Indirect: lateral to vessels, goes through internal inguinal ring –!Occur at any age –!Most common (2/3)

    •! Direct: Medial to vessels –!Most common in middle aged

    and elderly men

  • 8/26/18

    4

    Ultrasound Method •! Put probe lateral to vessels

    aligned with inguinal canal –!Supine –!Valsalva –!Standing if needed

    •! Repeat medial to vessels

    Left Indirect Inguinal Hernia

    Indirect Inguinal Hernia Indirect Inguinal Hernia

    Indirect Inguinal Hernia Inguinal Hernia: Reducible

  • 8/26/18

    5

    Inguinal Hernia: Not Reducible Indirect Inguinal hernia: Importance of Standing

    Direct Inguinal Hernia: Short Axis (Standing)

    Direct Inguinal Hernia Long Axis

    Spermatic Cord Lipoma

  • 8/26/18

    6

    Recurrent Inguinal Hernia 3 Surgeons Said No

    27-Year-Old Man With Pelvic Pain Scheduled for Orchiectomy

    Femoral hernias

    •! 3% of all hernias •! Originate below inguinal

    ligament, whereas inguinal hernias originate above

    Femoral hernia: 37 y.o. Woman Inguinal and Femoral Hernia

    91-Year-Old Man

  • 8/26/18

    7

    Inguinal and Femoral Hernia 91-Year-Old Man

    Inguinal and Femoral Hernia 91-Year-Old Man

    Inguinal and Femoral Hernia 91-Year-Old Man Sports Hernia

    •! Posterior inguinal wall deficiency •! Koulouris G. AJR 2008; 191:962. •! Also sometimes used to refer to

    groin pain in athletes: prefer “athletic pubalgia”

    Sports Hernia

    •! DDx: –! True hernias –!Rectus abdominis pathology –!Adductor tendon pathology –!Osteitis pubis

  • 8/26/18

    8

    “Sports Hernia” Distal Rectus Abdominis Tear

    *

    Distal Rectus Abdominis Tear

    *

    Partial Adductor Tendon Tear

    Adductor Tendons Normal Adductor Tendon

    L

    B

    M

  • 8/26/18

    9

    Adductor Tendinosis Adductor Tendinosis and Enthesopathy

    Adductor Longus Muscle Tear Cyst of Canal of Nuck “Female Hydrocele”

    Cyst of Canal of Nuck Hydrocele of Canal of Nuck

  • 8/26/18

    10

    Companion Case: 50 y.o. Man Companion Case: 50 y.o. Man

    Companion Case: 50 y.o. Man Companion Case: 50 y.o. Man

    Spigelian Hernia Spigelian Hernia

  • 8/26/18

    11

    References •! Jamadar DA, et al. Sonography of inguinal region

    hernias. AJR 2006; 187: 185-190 •! Jamadar DA, et al. Characteristic locations of

    inguinal region and anterior abdominal wall hernias: sonographic appearances and identification of clinical pitfalls. AJR 2007; 188:1356-1364

    •! Koulouris G. Imaging review of groin pain in elite athletes: an anatomic approach to imaging findings. AJR 2008; 191:962-972.