Femoral hernia diagnostic study of choice: Difference between revisions

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== Overview ==
== Overview ==
[[Ultrasound]] is the diagnostic study of choice for diagnosing femoral hernia as it has low cost, widespread availability and low risk of [[radiation exposure]]. If it is an emergent case with signs of [[Incarcerated hernia|incarceration]] that is difficult to diagnose based on [[clinical examination]], an [[abdominal]] [[CT scan]] must be performed to confirm the [[diagnosis]].


== Diagnostic Study of Choice ==
== Diagnostic Study of Choice ==
=== Study of choice: ===
=== Study of choice: ===
*Ultrasound is the diagnostic study of choice for the diagnosis of femoral hernia.
*[[Ultrasound]] is the diagnostic study of choice for the [[diagnosis]] of femoral hernia.<ref name="pmid25489584">{{cite journal |vauthors=Yang XF, Liu JL |title=Acute incarcerated external abdominal hernia |journal=Ann Transl Med |volume=2 |issue=11 |pages=110 |year=2014 |pmid=25489584 |pmc=4245506 |doi=10.3978/j.issn.2305-5839.2014.11.05 |url=}}</ref>
* The [name of the investigation] should be performed when:
*If it is an emergent case and the patient presents with signs of [[Incarcerated hernia|incarceration]] and it is difficult to diagnose based on clinical examination, an abdominal [[CT scan]] must be performed to confirm the [[diagnosis]].<ref name="WhalenKidd2011">{{cite journal|last1=Whalen|first1=H. R.|last2=Kidd|first2=G. A.|last3=O'Dwyer|first3=P. J.|title=Femoral hernias|journal=BMJ|volume=343|issue=dec08 1|year=2011|pages=d7668–d7668|issn=0959-8138|doi=10.1136/bmj.d7668}}</ref>
** The patient presented with symptoms/signs 1. 2, 3.
The [[sensitivity]] and [[specificity]] of [[ultrasound]] is as follows:<ref name="pmid12831490">{{cite journal |vauthors=Bradley M, Morgan D, Pentlow B, Roe A |title=The groin hernia - an ultrasound diagnosis? |journal=Ann R Coll Surg Engl |volume=85 |issue=3 |pages=178–80 |year=2003 |pmid=12831490 |pmc=1964363 |doi=10.1308/003588403321661334 |url=}}</ref><ref name="pmid18293054">{{cite journal |vauthors=Djuric-Stefanovic A, Saranovic D, Ivanovic A, Masulovic D, Zuvela M, Bjelovic M, Pesko P |title=The accuracy of ultrasonography in classification of groin hernias according to the criteria of the unified classification system |journal=Hernia |volume=12 |issue=4 |pages=395–400 |year=2008 |pmid=18293054 |doi=10.1007/s10029-008-0352-6 |url=}}</ref>
** A positive [test] is detected in the patient.
* [Name of the investigation] is the gold standard test for the diagnosis of [disease name].
* The diagnostic study of choice for [disease name] is [name of the investigation].
* There is no single diagnostic study of choice for the diagnosis of [disease name].
* There is no single diagnostic study of choice for the diagnosis of [disease name], but [disease name] can be diagnosed based on [name of the investigation 1] and [name of the investigation 2].
* Femoral hernia mainly diagnosed based on clinical presentation.
* Investigations:
** Among patients who present with clinical signs of [disease name], the [investigation name] is the most specific test for the diagnosis.
** Among patients who present with clinical signs of [disease name], the [investigation name] is the most sensitive test for diagnosis.
** Among patients who present with clinical signs of [disease name], the [investigation name] is the most efficient test for diagnosis.
The sensitivity and specificity of ultrasound is as follows:<ref name="pmid12831490">{{cite journal |vauthors=Bradley M, Morgan D, Pentlow B, Roe A |title=The groin hernia - an ultrasound diagnosis? |journal=Ann R Coll Surg Engl |volume=85 |issue=3 |pages=178–80 |year=2003 |pmid=12831490 |pmc=1964363 |doi=10.1308/003588403321661334 |url=}}</ref>{{cite journal |vauthors=Djuric-Stefanovic A, Saranovic D, Ivanovic A, Masulovic D, Zuvela M, Bjelovic M, Pesko P |title=The accuracy of ultrasonography in classification of groin hernias according to the criteria of the unified classification system |journal=Hernia |volume=12 |issue=4 |pages=395–400 |year=2008 |pmid=18293054 |doi=10.1007/s10029-008-0352-6 |url=}}
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[[File:Femoral-hernia-2.jpg|300px|thumb|center|'''Femoral hernia'''<br>'''[https://radiopaedia.org/cases/10124 Source: radiopaedia.org, Case courtesy of Dr Maulik S Patel >rID: 10124]''']]
===== Diagnostic results =====
===== Diagnostic results =====
*Findings on an ultrasound suggestive of femoral hernia include:<ref name="pmid25489584">{{cite journal |vauthors=Yang XF, Liu JL |title=Acute incarcerated external abdominal hernia |journal=Ann Transl Med |volume=2 |issue=11 |pages=110 |year=2014 |pmid=25489584 |pmc=4245506 |doi=10.3978/j.issn.2305-5839.2014.11.05 |url=}}</ref>
*Findings on an [[ultrasound]] suggestive of femoral hernia include:<ref name="pmid25489584">{{cite journal |vauthors=Yang XF, Liu JL |title=Acute incarcerated external abdominal hernia |journal=Ann Transl Med |volume=2 |issue=11 |pages=110 |year=2014 |pmid=25489584 |pmc=4245506 |doi=10.3978/j.issn.2305-5839.2014.11.05 |url=}}</ref>
**Expansion of the [[intestines]] with reverse [[peristalsis]]
**Expansion of the [[intestines]] with reverse [[peristalsis]]
**Fixed masses without [[peristalsis]]
**Fixed masses without [[peristalsis]]
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*Color [[doppler ultrasound]]  may be helpful in the diagnosis of complications of femoral hernia; incarceration by observing the [[blood]] supply in the contents of the [[hernia]] sac.<ref name="pmid25489584">{{cite journal |vauthors=Yang XF, Liu JL |title=Acute incarcerated external abdominal hernia |journal=Ann Transl Med |volume=2 |issue=11 |pages=110 |year=2014 |pmid=25489584 |pmc=4245506 |doi=10.3978/j.issn.2305-5839.2014.11.05 |url=}}</ref>
*Color [[doppler ultrasound]]  may be helpful in the diagnosis of complications of femoral hernia; incarceration by observing the [[blood]] supply in the contents of the [[hernia]] sac.<ref name="pmid25489584">{{cite journal |vauthors=Yang XF, Liu JL |title=Acute incarcerated external abdominal hernia |journal=Ann Transl Med |volume=2 |issue=11 |pages=110 |year=2014 |pmid=25489584 |pmc=4245506 |doi=10.3978/j.issn.2305-5839.2014.11.05 |url=}}</ref>


===== Sequence of Diagnostic Studies =====
===== Sequence of diagnostic studies =====
The ultrasound should be performed when:
The [[ultrasound]] should be performed when:<ref name="WhalenKidd2011">{{cite journal|last1=Whalen|first1=H. R.|last2=Kidd|first2=G. A.|last3=O'Dwyer|first3=P. J.|title=Femoral hernias|journal=BMJ|volume=343|issue=dec08 1|year=2011|pages=d7668–d7668|issn=0959-8138|doi=10.1136/bmj.d7668}}</ref>
* The patient presented with swelling or lump in the upper thigh as the first step of diagnosis.
* The patient presented with [[swelling]] or [[lump]] in the upper [[thigh]] as the first step of [[diagnosis]].
* If it is an emergent case with signs of incarceration, abdominal CT scan can be performed to confirm the diagnosis.
* If it is an emergent case with signs of incarceration, abdominal [[CT scan]] can be performed to confirm the diagnosis.


==References==
==References==
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Latest revision as of 16:20, 15 February 2018

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: M. Khurram Afzal, MD [2]

Overview

Ultrasound is the diagnostic study of choice for diagnosing femoral hernia as it has low cost, widespread availability and low risk of radiation exposure. If it is an emergent case with signs of incarceration that is difficult to diagnose based on clinical examination, an abdominal CT scan must be performed to confirm the diagnosis.

Diagnostic Study of Choice

Study of choice:

  • Ultrasound is the diagnostic study of choice for the diagnosis of femoral hernia.[1]
  • If it is an emergent case and the patient presents with signs of incarceration and it is difficult to diagnose based on clinical examination, an abdominal CT scan must be performed to confirm the diagnosis.[2]

The sensitivity and specificity of ultrasound is as follows:[3][4]

Sensitivity Specificity
Ultrasound 100% 100%
Femoral hernia
Source: radiopaedia.org, Case courtesy of Dr Maulik S Patel >rID: 10124
Diagnostic results
  • Color doppler ultrasound may be helpful in the diagnosis of complications of femoral hernia; incarceration by observing the blood supply in the contents of the hernia sac.[1]
Sequence of diagnostic studies

The ultrasound should be performed when:[2]

  • The patient presented with swelling or lump in the upper thigh as the first step of diagnosis.
  • If it is an emergent case with signs of incarceration, abdominal CT scan can be performed to confirm the diagnosis.

References

  1. ↑ 1.0 1.1 1.2 Yang XF, Liu JL (2014). "Acute incarcerated external abdominal hernia". Ann Transl Med. 2 (11): 110. doi:10.3978/j.issn.2305-5839.2014.11.05. PMC 4245506. PMID 25489584.
  2. ↑ 2.0 2.1 Whalen, H. R.; Kidd, G. A.; O'Dwyer, P. J. (2011). "Femoral hernias". BMJ. 343 (dec08 1): d7668–d7668. doi:10.1136/bmj.d7668. ISSN 0959-8138.
  3. ↑ Bradley M, Morgan D, Pentlow B, Roe A (2003). "The groin hernia - an ultrasound diagnosis?". Ann R Coll Surg Engl. 85 (3): 178–80. doi:10.1308/003588403321661334. PMC 1964363. PMID 12831490.
  4. ↑ Djuric-Stefanovic A, Saranovic D, Ivanovic A, Masulovic D, Zuvela M, Bjelovic M, Pesko P (2008). "The accuracy of ultrasonography in classification of groin hernias according to the criteria of the unified classification system". Hernia. 12 (4): 395–400. doi:10.1007/s10029-008-0352-6. PMID 18293054.

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