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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
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Iliopsoas Bursitis Iliopsoas Bursitis
Iliopsoas Bursitis Normal Iliopsoas Motion
Snapping Iliopsoas Tendon Snapping Iliopsoas Tendon: Harmonic Imaging
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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
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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
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Inguinal Hernia: Not Reducible Indirect Inguinal hernia: Importance of Standing
Direct Inguinal Hernia: Short Axis (Standing)
Direct Inguinal Hernia Long Axis
Spermatic Cord Lipoma
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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
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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
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“Sports Hernia” Distal Rectus Abdominis Tear
*
Distal Rectus Abdominis Tear
*
Partial Adductor Tendon Tear
Adductor Tendons Normal Adductor Tendon
L
B
M
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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
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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
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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.