Scanning for groin hernias: Five Top Tips

Senior Sonographer at East & North Hertfordshire NHS Trust, Hazel Edwards has put together Five Top tips for Scanning Groin Hernias

1.  Good valsalva.  Take time at the start of the exam to ensure the patient understands how to increase their abdominal pressure on command and in a controlled manner.  Reducible hernias may be missed if patients fail to do this.  Use coughing only as a last resort.

2.  Transducer.  A mid-range frequency linear transducer on a 'bowel' preset gives the depth and contrast needed.  MSK presets with a high dynamic range may produce images that are too smooth and grey.

3.  The lightest touch.  Don't be too heavy handed with the transducer or you may fail to see the hernia.  And make sure the patient has an empty bladder; full bladders may distort anatomy and keep a hernia hidden.

4.  Flexible approach.  Scan systematically through the inguinal region but also listen carefully to how the patient describes their discomfort.  Ask them to point to the area of concern.  Hernias may be more medial than expected and sometimes it helps to compare with the contralateral side or to scan while the patient stands.

5.  Reporting.  When you find a hernia, the referring clinician wants to know four things: Location?  Is it reducible?  What's in it?  Is the neck big or small?