Article

Abdominal wall ultrasound and hernias

Abdominal wall ultrasound for hernias: technique with the Valsalva maneuver, hernia types, rectus diastasis, reducibility, normal report and limitations.

What it is and when to indicate it

Abdominal wall ultrasound looks for hernias and other wall lesions (bulges, collections, scar endometriosis, rectus diastasis). It is a dynamic exam: the strain maneuver is an essential part of the method.

This page organizes the protocol in clear language and does not replace the original guidelines (AIUM, EFSUMB, CBR), supervised training or clinical correlation.

Preparation and technique

• No preparation required; high-frequency linear transducer (7 to 15 MHz)
• Dynamic exam: assess at rest and during Valsalva/strain and in the standing position
• Mark the symptomatic point indicated by the patient and scan over it
• Identify the fascial defect, its size (neck) and the hernia content
• Test reducibility with compression and change of position

What to characterize in a hernia

• Location and type: inguinal, femoral, umbilical, epigastric, incisional, Spigelian
• Size of the defect (neck) and dimensions of the hernia sac
• Content: preperitoneal fat, bowel loop (with peristalsis), fluid
• Reducibility: reducible, partially reducible or irreducible
• Signs of complication: irreducibility, absent peristalsis, fluid, wall hyperemia (incarceration/strangulation)

Rectus diastasis and other lesions

• Rectus diastasis: separation of the rectus muscles with a widened linea alba, measured at rest and on strain
• Scar endometriosis: solid hypoechoic nodule in a surgical scar, usually cyclical
• Postoperative collections: seroma, hematoma, abscess
• Lipomas and other soft-tissue masses of the wall
• Differentiate a true hernia from a bulge due to muscle weakness without a fascial defect

Normal report template

• Preserved musculoaponeurotic planes of the abdominal wall
• No fascial defect or hernia sac, including on the Valsalva maneuver
• Linea alba of normal thickness, without significant rectus diastasis
• No collections or masses in the wall
• Symptomatic point examined without structural alterations

Limitations and pitfalls

• Not performing the strain maneuver and missing hernias that only appear on Valsalva
• Mistaking protruding preperitoneal fat for a bulge without a defect
• Not examining the exact point of the complaint
• Small reducible hernia absent at rest — always use dynamic maneuvers
• Report limitations and the dynamic nature of the exam

Do not overdiagnose

Differentiate a true hernia (fascial defect with content) from a bulge due to weakness. Signs of complication require communication and prompt management. Describe the defect, the content and the reducibility objectively.

Sources

Educational content; it does not replace original guidelines, medical evaluation or supervised training. Main references:

• EFSUMB. Guidelines and recommendations on abdominal wall ultrasound (didactic support).
• AIUM. Practice Parameter for the Performance of an Ultrasound Examination of the Abdominal Wall (when applicable).
• Brazilian College of Radiology (CBR). Standardization and technical guidelines for ultrasound.
• Rumack CM, Levine D. Diagnostic Ultrasound (abdominal wall and hernias).
• Radiopaedia. Abdominal wall hernia ultrasound (didactic support, not copied).

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