Transcript
Page 1: US medial hip and thigh Pitt 2018 Conference/US... · Sartorius Tear Inguinal Hernia Epidemiology •!Most common hernia type •!More than 1 million hernias repaired each year in

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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.