Article

Inguinal region ultrasound

Inguinal region ultrasound: dynamic technique, direct and indirect inguinal hernia, femoral hernia, lymph nodes, normal report and limitations.

What it is and when to indicate it

Inguinal region ultrasound assesses groin bulges and pain, being the dynamic method of choice for inguinal and femoral hernias, as well as lymph nodes and other regional lesions. The strain maneuver is essential.

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

Reference anatomy

• Inferior epigastric vessels: divider between indirect (lateral) and direct (medial) inguinal hernia
• Deep inguinal ring and the course of the inguinal canal
• Inguinal ligament and the femoral vein, reference for the femoral hernia (medial to the vein)
• Spermatic cord/round ligament within the canal
• Superficial and deep inguinal lymph nodes

Dynamic technique

• High-frequency linear transducer (7 to 15 MHz)
• Assess at rest and during Valsalva, supine and standing
• Locate the inferior epigastric vessels to classify the hernia
• Measure the defect neck and characterize the content (fat, loop with peristalsis)
• Test reducibility and look for signs of complication

Hernia types and differentiation

• Indirect inguinal: emerges lateral to the inferior epigastric vessels, descends through the canal
• Direct inguinal: protrudes medial to the vessels, through the canal floor
• Femoral: medial to the femoral vein, below the inguinal ligament (higher risk of incarceration)
• Differentiate from lymphadenopathy, varices and other masses
• Signs of complication: irreducibility, absent peristalsis, fluid, hyperemia

Normal report template

• Inguinal regions without a wall defect or hernia sac, including on the Valsalva maneuver
• Inferior epigastric and femoral vessels identified, without an adjacent hernia
• No femoral hernia below the inguinal ligament
• Inguinal lymph nodes of usual appearance, when visible
• Symptomatic point examined without structural alterations

Limitations and pitfalls

• Not using dynamic maneuvers and missing small reducible hernias
• Mistaking preperitoneal fat for a hernia without a clear defect
• Not classifying relative to the epigastric vessels
• Reactive lymph node mistaken for a mass
• Report limitations and the dynamic nature of the exam

Do not overdiagnose

Classify the hernia by its relation to the vessels and the inguinal ligament, characterize the content and reducibility, and value signs of complication. Describe objectively and correlate with the clinical picture.

Sources

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

• EFSUMB. Guidelines and recommendations on groin and abdominal wall ultrasound (didactic support).
• AIUM. Practice Parameter for the Performance of Ultrasound of Superficial Structures (when applicable).
• Brazilian College of Radiology (CBR). Standardization and technical guidelines for ultrasound.
• Rumack CM, Levine D. Diagnostic Ultrasound (inguinal region).
• Radiopaedia. Inguinal hernia ultrasound (didactic support, not copied).

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