Stephen Bird

These can be tricky,

I don’t think you have a significant femoral hernia here,

You have to be really careful about the exact level that you do your assessment.

I have to record the hernia lecture into a webinar and load it up on the website.

Many people have been asking for it and it is on my list of recordings to do next.

The key to femoral hernia assessment is getting the correct anatomical plane where the femoral ring is. Anatomically the femoral ring is at the level of the inguinal ligament, however this can be hard to visualise.
I use a different trick that makes it easy. I find the common femoral artery and vein and scan it at the level where I can see the pectinous muscle on top of the bony iliopectineal eminence. If yo are 1cm distal to the correct location you can’t see the bony iliopectineal eminence and if you are 1c, proximal to the correct spot you won’t see the pectinous muscle. I think on your images you are a touch proximal and that is why you are seeing normal peritoneal fat moving adjacent to the common femoral vein.
With a real hernia you also usually get CFV compression as the hernia presents.

Try this and see how you go.

Feel free to load up your next images and I will take a look at them,


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