?Femoral Hernia

[Diane]

Hi Steve,

We had this 70 year old lady come in for general pelvic pain. A possible femoral hernia was found and she re-presented 2 days later to have it “confirmed”.
The reporting radiologist on the day wasn’t convinced of a femoral hernia. I was a bit unsure too… I was on the fence. Could the hypoechoic appearance be just fat continuing from the lower abdomen?

Cine loops and some images attached. Any opinions would be great.

Thanks!

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[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,

Steve

[Diane]

Hi Steve,

I scanned another femoral hernia (before you gave you advice about the pectineus muscle). I thought this one was a bit more convincing of a femoral hernia? Also did I label the pectineus muscle correctly on the attached image?

Any thoughts?

(Keen for hernia lecture!)

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[Stephen Bird]

Yes, the pectinous label is perfect,

I agree this is a small femoral hernia,

However it is only small,

I think these small hernias when they look like this and clinical correction is required as it may not need treatment.

I see these small femoral hernia (laxity) cases regularly.

The key feature is that the femoral vein is not completely obliterated and only a small tongue of fat passes through the femoral ring just medial to the vessels at the pectinous level.

I describe these on my worksheet as some “laxity” of the femoral ring requiring clinical correlation.

You have produced beautiful images Diane.

Steve

Steve

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