25, No. This region is conceptually simpler than the inguinal canal. 37, No. 27, No. Figure 13. Inguinal hernias are the most common and can be subdivided into direct and indirect types. Other features of the femoral triangle include the femoral nerve, which lies lateral to the sheath, and the great saphenous vein, which passes through a hole in the deep fascia (the saphenous opening) to join the common femoral vein. An inguinal hernia is the most common type of hernia (about 70% of hernias are inguinal) and usually manifests as a small lump in the groin area. The differential diagnosis for inguinal mass is somewhat broad . Inguinal hernias usually occur in the area where the uterus's connective tissues attach to other tissues that are around the pubic bone. (c) Subsequent contrast-enhanced pelvic CT scan shows a large inguinal hernia containing ascites (∗). The color Doppler signal in the hernia at US represents flow of ascites. Among vascular conditions, false aneurysms may be detected from the turbulent flow through the tract at Doppler US. )Download as PowerPointOpen in Image Contrast-enhanced CT scan shows an irregular subcutaneous soft-tissue mass (solid arrow) abutting the spermatic cord (open arrow). The processus vaginalis peritonei (called the canal of Nuck in the female) is a tubular fold of peritoneum that invaginates into the inguinal canal anterior to the gubernaculum and descending testis, ending in the scrotum (,Fig 5). A direct hernia passes medially to the inferior epigastric vessels through a defect in the Hesselbach triangle (a potential weak point of the anterior abdominal wall bounded by the inguinal ligament inferiorly, the inferior epigastric artery superolaterally, and the conjoint tendon [representing the fused aponeuroses of the internal oblique and transverse abdominal muscles] medially) (,,,,Fig 7). It will often feel soft; however, it can also feel firm depending on what has caused it. 9, No. 31, No. Viewer. Biopsy findings confirmed synovial osteochondromatosis.Download as PowerPointOpen in Image (Reprinted, with permission, from reference ,3. Right groin mass in a middle-aged woman with no recent history of trauma or instrumentation. Fat surrounds the spermatic cord (arrowhead) where it enters the deep inguinal ring. Figure 6a. to image a groin mass, a significant number of masses in the inguinal region are discovered inci-dentally during cross-sectional imaging for other indications. Figure 14. Being white. Viewer. Groin mass in a 50-year-old man. Its location indicates that this is a direct hernia. (c) Axial T1-weighted MR image obtained at a higher level than a and b shows the loop of bowel (white arrow) lying medial to the inferior epigastric artery (solid black arrow) and behind the external oblique aponeurosis (open arrow) in the region of the Hesselbach triangle. 3, Journal of Nippon Medical School, Vol. The origin of the hernia (arrowhead) is medial to a dilated inferior epigastric vein (arrow), making this a direct hernia. Men are eight times more likely to develop an inguinal hernia than are women. Viewer. In the female, it becomes attached at its midpoint to the uterus, with two outcomes: (a) The ovary is prevented from descending into the inguinal canal, and (b) anterior tension on the uterus results in the normal anatomic position of anteversion and anteflexion. Have you noticed a lump in your groin area? 1, 10 November 2016 | Pediatric Radiology, Vol. 7, 1 May 2007 | Journal of Ultrasound in Medicine, Vol. 2, No. 4, 1 December 2007 | Journal of Ultrasound in Medicine, Vol. Viewer, Figure 4. A lump in stomach or abdominal mass is an appearance of a bulge or swelling, which may originate or may be present in any region of the abdomen. The origin of the hernia (arrowhead) is medial to a dilated inferior epigastric vein (arrow), making this a direct hernia. For example, the iliopectineal bursa may become inflamed and result in a painful groin mass (,,,Fig 10), as may large joint effusions and synovial proliferative diseases such as synovial osteochondromatosis (,Fig 11). Pediatr Surg … 19, No. Testicular descent may be interrupted in the inguinal canal, resulting in an undescended testis (with an associated increased risk for malignancy). 35, No. The pelvic mass was removed laparoscopically, while the inguinal mass was resected en bloc during inguinal radical orchiectomy. 11, Radiologic Clinics of North America, Vol. Permission to reprint this figure electronically has expired. The origin of the hernia (arrowhead) is medial to a dilated inferior epigastric vein (arrow), making this a direct hernia. Enter your email address below and we will send you the reset instructions. 5, No. The origin of the hernia (arrowhead) is medial to a dilated inferior epigastric vein (arrow), making this a direct hernia. 10, No. (a) Unenhanced CT scan shows a low-attenuation region (arrow) within the iliopsoas muscle. Huang CS, Luo CC, Chao HC, et al. Fat surrounds the spermatic cord (arrowhead) where it enters the deep inguinal ring. A femoral hernia lies in the femoral canal, medial to the femoral vein. Viewer. 34, No. (c) Axial T1-weighted MR image obtained at a higher level than a and b shows the loop of bowel (white arrow) lying medial to the inferior epigastric artery (solid black arrow) and behind the external oblique aponeurosis (open arrow) in the region of the Hesselbach triangle. 6, 7 April 2012 | International Journal of Hematology, Vol. A recent increase in both types of cases at our institutions prompted a review of the complex anatomy of this region, reinforcing the notion that a firm grasp of the component struc- In one review, the median age at presentation was 60 to 79 years of age for women compared with 50 to 69 years of age for men [ 6 ]. Groin pain and limitation of hip flexion in a 41-year-old woman. This is the classic location of the iliopectineal bursa, which in this case is inflamed. A range of masses can manifest in the region encompassing the femoral triangle and the inguinal canal in women. An inguinal hernia occurs when fatty tissue or part of the small intestine bulges through a weakened muscle in the lower abdominal wall. Herniation of abdominal or pelvic contents in this region may be divided into two main categories: inguinal and femoral. Chronic constipation. Pregnancy. Metastases occur most frequently in the lymph nodes or bone tissue. Its location indicates that this is a direct hernia.Download as PowerPointOpen in Image The superficial inguinal lymph nodes, which are arranged in vertical and horizontal groups, form a rough T shape. Groin masses … Spleen. Figure 3b shows a sagittal view of an indirect inguinal hernia exiting the abdominal cavity through deep inguinal ring anterior to the inferior epigastric vessels during valsalva. Figure 14. Causes of inguinal hernia in women. (c) The spermatic cord is at the superficial inguinal ring (short solid arrow). Fat surrounds the spermatic cord (arrowhead) where it enters the deep inguinal ring. Biopsy findings confirmed synovial osteochondromatosis. The femoral canal lies laterally and contains the common femoral vessels (arrowhead) and node of Cloquet (open arrow).Download as PowerPointOpen in Image The indirect inguinal hernia is located anterior and lateral to the inferior epigastric vessels. MR imaging allowed better depiction of the fluid nature of the bursa and greater diagnostic confidence.Download as PowerPointOpen in Image Your abdomen contains many different structures, including your: Stomach and gut (bowel). Inguinal “lump” in an elderly man. Although a radiologist may be specifically asked to image a groin mass, a significant number of masses in the inguinal region are discovered incidentally during cross-sectional imaging for other indications. This finding highlights the importance of optimizing Doppler US settings; the “neck” of the apparent pseudoaneurysm at US represents artifact from an incorrect gain setting.Download as PowerPointOpen in Image The five major groups of pathologic conditions manifesting as masses in this region are briefly discussed and illustrated. [scielo.br] Paratesticular liposarcoma is a rare condition characterized by a growing, painless inguinal , or scrotal mass . The most common benign tumor of the inguinal canal is a lipoma (,,,Fig 12); tumors arising from the ductus deferens itself are extremely rare. 67, No. 2, Clínica e Investigación en Ginecología y Obstetricia, Radiología (English Edition), Vol. The inguinal ligament (long arrow) is shown. 26, No. Your doctor will check for a bulge in the groin area. Inguinal “lump” in an elderly man. The long adductor muscle, which is not shown, lies medial and anterior to the pectineal muscle. (c) Axial T1-weighted MR image obtained at a higher level than a and b shows the loop of bowel (white arrow) lying medial to the inferior epigastric artery (solid black arrow) and behind the external oblique aponeurosis (open arrow) in the region of the Hesselbach triangle. Inguinoscrotal “lump” of several years duration in a 66-year-old man. An encysted hydrocele of the canal of Nuck was diagnosed. The groin is a common site for a hernia, and there are three types of hernia which can occur here: An inguinal hernia - more common in males. Coronal T1-weighted magnetic resonance (MR) image shows the gubernaculum (open arrows) and undescended gonads (solid arrow). The contents of the spermatic cord (,Fig 3) are (a) the ductus (vas) deferens and its artery, (b) the testicular artery and venous (pampiniform) plexus, (c) the genital branch of the genitofemoral nerve, (d) lymphatic vessels and sympathetic nerve fibers, and (e) fat and connective tissue surrounding the cord and its coverings in various amounts (,Fig 3). The color Doppler signal in the hernia at US represents flow of ascites. Ollero Fresno JC, Alvarez M, Sanchez M, Rollán V. Femoral hernia in childhood: review of 38 cases. 5. Viewer, Figure 9. It attaches inferiorly to the skin of the fetal groin that later forms the scrotum or labium majus and superiorly to the lower pole of the fetal gonad (,Fig 5). A combination of the clinical history, anatomical classification, and unique imaging features can aid clinicians in an accurate diagnosis of the inguinal or inguinofemoral mass in the female groin region. 5, 7 March 2011 | RadioGraphics, Vol. )Download as PowerPointOpen in Image Primary tumors may arise from any of the component structures: connective tissue (including tendon, cartilage, and bone), muscle, fat, blood vessels, and lymphoid tissue. No communication with the peritoneal cavity was seen, and no change occurred with the Valsalva maneuver. Figure 6b. Drawing shows a transverse section of the spermatic cord (at the level of the scrotum). (Reprinted, with permission, from reference ,3. (a, b) Color (a) and spectral (b) Doppler US scans are suggestive of venous flow (solid arrow in a) within a cystic right groin mass (∗ in a) apparently in continuity with the femoral vein (open arrow in a); a provisional diagnosis of venous pseudoaneurysm was made. These groin masses can be classified as being neoplasms, infectious or inflammatory processes, vascular conditions, as well as congenital abnormalities. 2, No. An uncomplicated inguinal hernia typically manifests as a mass in the groin with or without pain (inguinodynia). Figure 12a. (a, b) Coronal (a) and axial (b) T1-weighted MR images show a loop of small bowel in the left side of the scrotum (arrow). 3, 28 May 2018 | Radiologia Brasileira, Vol. 6, International Journal of Surgery Case Reports, Vol. (The origin of this hernia medial to the inferior epigastric vessels was confirmed on images obtained at a level superior to that shown here.) The broad clinical term inguinal region encompasses two adjacent but anatomically distinct areas: the inguinal canal and the femoral triangle. 4, 1 December 2011 | Journal of Ultrasound in Medicine, Vol. Eur J Pediatr 2003; 162:493. (b) T2-weighted MR image obtained with fat saturation helps confirm the region as a fluid collection (arrow). Known metastatic melanoma in a young male patient. (The right gonadal vein drains directly into the inferior vena cava. Viewer. Although complex, the embryologic knowledge required to understand the anatomic and pathologic characteristics of the inguinal canal can be centered around two main structures: the gubernaculum testis and processus vaginalis. 3, Case Reports in Obstetrics and Gynecology, Vol. US can be used to direct percutaneous aspiration biopsy. Factors that contribute to developing an inguinal hernia include: 1. The upper part usually closes at or just before birth, and obliteration proceeds gradually in a downward direction. Lipoma may be difficult to distinguish from herniation of properitoneal fat into the inguinal canal, which may cause similar imaging findings. Axial T1-weighted MR image (a) and sagittal T2-weighted MR image (b) show a lipoma of the cord extending superiorly into the inguinal canal (arrow in a) and inferiorly into the scrotum (solid arrow in b), displacing the testis (open arrow in b) posteriorly. 51, No. It follows the path of the inguinal canal inferomedially. Figure 10b. Kidneys and bladder. Varicoceles occur more frequently on the left owing to drainage of the left gonadal vein into the left renal vein. (a, b) Color (a) and spectral (b) Doppler US scans are suggestive of venous flow (solid arrow in a) within a cystic right groin mass (∗ in a) apparently in continuity with the femoral vein (open arrow in a); a provisional diagnosis of venous pseudoaneurysm was made. In this article, we describe the complex anatomic and embryologic characteristics of the groin, with the use of anatomic illustrations and corresponding cross-sectional images. 3, American Journal of Roentgenology, Vol. (a, b) Color (a) and spectral (b) Doppler US scans are suggestive of venous flow (solid arrow in a) within a cystic right groin mass (∗ in a) apparently in continuity with the femoral vein (open arrow in a); a provisional diagnosis of venous pseudoaneurysm was made. (c) The spermatic cord is at the superficial inguinal ring (short solid arrow). Right groin pain and a small fluctuant groin mass in a middle-aged woman. Contrast-enhanced CT scan shows an irregular subcutaneous soft-tissue mass (solid arrow) abutting the spermatic cord (open arrow). The characteristic venous flow of varicoceles is best diagnosed with US during the Valsalva maneuver. Right groin pain and a small fluctuant groin mass in a middle-aged woman. Normal anatomic characteristics of the groin on contrast-enhanced computed tomographic (CT) scans obtained at the level of the hip joint, from superior (a) to inferior (c). Pelvic masses may originate from either the gynecologic organs, such as the cervix, uterus, uterine adnexa, or from other pelvic organs, such as the intestines, bladder, ureters, and renal organs. 4, Seminars in Ultrasound, CT and MRI, Vol. This finding highlights the importance of optimizing Doppler US settings; the “neck” of the apparent pseudoaneurysm at US represents artifact from an incorrect gain setting. (a) The inferior epigastric artery (short arrow) arises from the external iliac artery (long arrow). The inguinal ligament (long arrow) is shown. Each fascial layer provides another coat or covering for the spermatic cord; thus, there are three coverings of the cord from outermost to innermost: (a) external spermatic fascia (derived from external oblique aponeurosis), (b) cremaster muscle and fascia (derived from the internal oblique and transverse muscles of the abdomen), and (c) internal spermatic fascia (derived from transverse fascia). Femoral hernias develop as a bulge below the inguinal ligament and lateral to the pubic tubercle. See print version. Illustration of the femoral canal and femoral sheath. No communication with the peritoneal cavity was seen, and no change occurred with the Valsalva maneuver. Obesity can make the identification of inguinal or femoral hernias on exam very challenging. Right groin pain and a small fluctuant groin mass in a middle-aged woman. (b) The inguinal ligament (short arrow), spermatic cord in the inguinal canal (long arrow), and normal superficial lymph node (arrowhead) are shown. Inguinal “lump” in an elderly man. 11, 19 April 2018 | Insights into Imaging, Vol. (c) Subsequent contrast-enhanced pelvic CT scan shows a large inguinal hernia containing ascites (∗). The canal is simply the medial half of the thickened lower free edge of the external oblique anastomosis (also known as the inguinal ligament), which curls back on itself to form a gutter that is U-shaped in cross section (,Fig 1). This is the classic location of the iliopectineal bursa, which in this case is inflamed. The inguinal ligament (long arrow) is shown. In the male, it assists in descent of the testis through the inguinal canal and into the scrotum and leaves no remnant in the adult. An indirect hernia originates at the deep inguinal ring, lateral to the inferior epigastric vessels. The long adductor muscle, which is not shown, lies medial and anterior to the pectineal muscle. Inguinal masses in women are rare entities, located in the groin area where the upper leg meets with... 2. Introduction. MR imaging allowed better depiction of the fluid nature of the bursa and greater diagnostic confidence. Liver. The femoral canal lies laterally and contains the common femoral vessels (arrowhead) and node of Cloquet (open arrow). Figure 2b. Inguinoscrotal “lump” of several years duration in a 66-year-old man. CT and MR imaging allow assessment of the origin of the tumor, although imaging appearances of solid tumors are relatively nonspecific. Axial contrast-enhanced CT scan shows an incidental finding of multiple enhancing tubular structures within the canal (arrow), representing a varicocele. Inguinal hernia Inguinal hernias are another possible cause of one-sided groin pain. Its borders are as follows: the inguinal ligament (superior); medial border of the long adductor muscle (medial); the medial border of the sartorius muscle (lateral); and the iliopsoas, pectineal, and long adductor muscles (floor). Congenital hernias are usually indirect, and the hernia contents include bowel loops, omental fat, or peritoneal fluid. Hernias diagnosed at CT or MR imaging are usually incidental discoveries; however, the relationship of the hernia to the hypogastric vessels as seen at CT or MR imaging allows easy distinction between direct and indirect hernial paths. Retroperitoneal lymphadenopathy in a 32-year-old man. Right groin mass in a middle-aged woman with no recent history of trauma or instrumentation. IH is a clinical diagnosis. 1, No. Both men and women can get inguinal hernias, but it’s apparently more common in men. Lipoma may be difficult to distinguish from herniation of properitoneal fat into the inguinal canal, which may cause similar imaging findings.Download as PowerPointOpen in Image The presentation of asymptomatic palpable movable mass in female inguinal hernia. (b) The inguinal ligament (short arrow), spermatic cord in the inguinal canal (long arrow), and normal superficial lymph node (arrowhead) are shown. Viewer, Anatomy and pathology of the canal of Nuck, Multidetector CT of iatrogenic and self-inflicted vascular lesions and infections at the groin, Patterns of surgical causes of inguinoscrotal lesions in neonates in Sohag, Upper Egypt, Canal of Nuck hernia containing pelvic structures presenting as a labial mass, Ultrasound evaluation of inguinoscrotal pain: an imaging-based review for the ultrasonographer, Lipoma of the fossa femoralis mimicking a femoral hernia. The main cause of this condition is the physiological characteristics of women, even during intrauterine development in the abdominal cavity develops a hole (in boys through a similar hole the testicles descend into the scrotum). This case highlights the utility of US in this setting, in particular its “real-time” nature and ability to precisely depict superficial structures. See print version.Download as PowerPointOpen in Image An abdominal mass is a lump in your tummy and can be due to a cyst or abnormal growth in the stomach, abdominal tumor, aortic aneurysm and other causes. Figure 2a. Figure 12b. An encysted hydrocele of the canal of Nuck was diagnosed. https://doi.org/10.1016/j.tria.2018.04.003. 30, No. Such pressure may be caused by pregnancy, obesity, chronic coughing spells, chronic constipation or extreme physical exertion. 24, No. (a, b) Color (a) and spectral (b) Doppler US scans are suggestive of venous flow (solid arrow in a) within a cystic right groin mass (∗ in a) apparently in continuity with the femoral vein (open arrow in a); a provisional diagnosis of venous pseudoaneurysm was made. A hernia may develop over time when a weak spot exists at birth. (c) Subsequent contrast-enhanced pelvic CT scan shows a large inguinal hernia containing ascites (∗). 5, EMC - Radiologie et imagerie médicale - Abdominale - Digestive, Vol. An abscess is a tender mass … 15, No. In the male, the scrotal section remains patent, forming the tunica vaginalis testis; in the female, the entire processus normally becomes obliterated. We use cookies to help provide and enhance our service and tailor content and ads. Its location indicates that this is a direct hernia. Strangulation of hernial contents are collectively referred to as complicated inguinal hernia containing ascites ( ∗ ) or. Femoral sheath (, Fig 4 ) bulge below the inguinal ligament use efficiently! 2017 | Pediatric Radiology, Vol of one-sided groin pain and limitation of flexion. 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