Differential Diagnosis of Inguinal and Femoral Hernia on Multi-detector Row CT

Transcription

1 Differential Diagnosis of Inguinal and Femoral Hernia on Multi-detector Row CT Poster No.: C-1923 Congress: ECR 2014 Type: Authors: Keywords: DOI: Scientific Exhibit S. Zhao 1, Z. Huang 1, R. LIU 2 ; 1 Chengdu/CN, 2 Chengdu, Sichuan/ CN Abdomen, Anatomy, CT, Computer Applications-3D, Hernia /ecr2014/C-1923 Any information contained in this pdf file is automatically generated from digital material submitted to EPOS by third parties in the form of scientific presentations. References to any names, marks, products, or services of third parties or hypertext links to thirdparty sites or information are provided solely as a convenience to you and do not in any way constitute or imply ECR's endorsement, sponsorship or recommendation of the third party, information, product or service. ECR is not responsible for the content of these pages and does not make any representations regarding the content or accuracy of material in this file. As per copyright regulations, any unauthorised use of the material or parts thereof as well as commercial reproduction or multiple distribution by any traditional or electronically based reproduction/publication method ist strictly prohibited. You agree to defend, indemnify, and hold ECR harmless from and against any and all claims, damages, costs, and expenses, including attorneys' fees, arising from or related to your use of these pages. Please note: Links to movies, ppt slideshows and any other multimedia files are not available in the pdf version of presentations. Page 1 of 8

2 Aims and objectives To assess the value of multi-detector row computed tomography (MDCT) in differential diagnosis of the inguinal and femoral hernias. Methods and materials We retrospectively reviewed the CT images of patients with clinical confirmed hernias: 146 indirect and 82 direct inguinal hernia, and 32 femoral hernia patients. The axial source images were used to obtain the coronal and sagittal views with multi-planar reconstruction. We evaluated the presence of hernia, extent of hernias based on the relationship between the hernia sacs and the anatomical structures in the groin area. Results 157 hernia sacs in 146 indirect hernia patients (75 right, 60 left and 11 bilateral) were found originating laterally to the inferior epigastric artery and entering the inguinal canal through the deep ring, anterior (103/157, 65.6%) or anteromedial (36/157, 22.9%) to the spermatic cord or round ligament; 91 hernia sacs in 82 direct hernia patients (39 right, 34 left and 9 bilateral) originated medially to the inferior epigastric artery, medial to the spermatic cords. Both indirect and direct hernia sacs located anterosuperior to the inguinal ligament; 32 sacs in 32 femoral hernia patients (17 right and 15 left) located posteriorly to the inguinal ligament and inside the "radiological femoral triangle" on coronal reformat. Images for this section: Page 2 of 8

3 Fig. 1: CT images of a 60-year male patients with right-side indirect hernia. Axial image#coronal image#and sagittal image of CT showed that hernia sac#hollow white arrow# had contained small bowel and mesentery#which originated lateral to the course of the right inferior epigastric artery white arrow head##and passed anterior to the right inguinal ligament #thin white arrow# Page 3 of 8

4 Fig. 2: CT images of a 60-year male patients with right-side indirect hernia. Axial image#coronal image#and sagittal image of CT showed that hernia sac#hollow white arrow# had contained small bowel and mesentery#which originated lateral to the course of the right inferior epigastric artery# white arrow head##and passed anterior to the right inguinal ligament# thin white arrow# Page 4 of 8

5 Fig. 3: CT images of a 60-year male patients with right-side indirect hernia.axial image#coronal image#and sagittal image of CT showed that hernia sac# hollow white arrow# had contained small bowel and mesentery#which originated lateral to the course of the right inferior epigastric artery# white arrow head##and passed anterior to the right inguinal ligament# thin white arrow# Page 5 of 8

6 Fig. 4: CT images of a 66-year male patient with right femoral hernia. Coronal image of CT showed that hernia sac# hollow white arrow# had contained small bowel#originated medial to the course of the right femoral vein# white arrow head##prolapsed posteroinferior to the inguinal ligament# thin white arrow##and filled the radiological femoral triangle# dash line triangle##there was no change at the left radiological femoral triangle# solid line triangle# Page 6 of 8

7 Conclusion The MPR images available from MDCT allow an accurate diagnosis of groin hernias. On the reconstructed images, direct and indirect inguinal hernias and femoral hernias can be reliably distinguished by simply identifying evident anatomical markers. Personal information References [1]. Van den Berg JC, de Valois JC, Go PM, et al. Radiological anatomy of the groin region [J]. Europe Radiology. 2000;10(4): [2]. Cherian PT, Parnell AP. The radiological anatomy of the inguinofemoral region: new insights from multi-slice spiral computerized tomography [J]. AJR Am J Roentgenol. 2007;189(4):W [3]. Cherian PT, Parnell AP. The diagnosis and classification of inguinal and femoral hernia on multisection spiral CT [J]. Clinical Radiology.2008; 63(2): [4]. Stabile Ianora AA, Midiri M, Vinci R, et al. Abdominal wall hernias: imaging with spiral CT. Eur Radiol 2000,10: [5]. Delabrousse E, Michalakis D, Sarlieve P, et al. Value of the pubic tubercle as a CT reference point in groin hernias. J Radiol, 2005, 86(6): [6]. ZHAO S, HUANG ZX, LIU RB et al. CT Radiological Anatomy of Adult Groin Region. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY [J], 2010,17(5): [7]. ZHAO S, LIU RB, Zhou Y et al. Diagnosis of Inguinal Region Hernia in Multi-detector Row CT [J]. West China Medical Journal. 2010, 09: [8]. Burkhardt JH, Arshanskiy Y, Munson JL, et al. Diagnosis of inguinal region hernias with axial CT: the lateral crescent sign and other key findings [J]. Radiographics. 2011,31(2):E1-12 [9]. Kitami M, Takase K, Tsuboi M, at el. Differentiation of Femoral and Inguinal Hernias on the Basis of Anteroposterior Relationship to the Inguinal Ligament on Multidimensional Computed Tomography[J]. J Comput Assist Tomogr. 2009; 33(5): Page 7 of 8

8 [10]. Suzuki S, Furui S, Okinaga K, at el. Differentiation of femoral versus inguinal hernia: CT findings [J]. AJR Am J Roentgenol. 2007; 189(2):W Page 8 of 8