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What to tell the ultra sound technician
An ultrasound looking for an inguinal or groin hernia should be ordered specifically as a “dynamic hernia ultrasound.”
The patient should be asked to stand, lie flat, cough, push belly out, rotate hip out, and walk around if necessary. Ie, if a hernia is not visualizable at the groin, then much time needs to be spent to actively force out a hernia, using Gravity and pushing out (bearing down) movements. Videos should be taken of the area and reviewed. Also, in women especially, the femoral region should also be reviewed as should any scars in the area, such as from a Cesarean section.
Ultrasounds are best performed by a skilled radiologist. But, nowadays, that is hard to find. I have one in my town who does it and he is very excellent at it. Most of the time, however, it is done by a technologist and then the still pictures and maybe some video clips are sent to the radiologist to review, without any patient interaction. This, the quality of the images and interpretation are very technician-dependent. As a result, I see a lot of falsely negative ultrasounds in my practice.
If an ultrasound is “negative” and there is high clinica suspicion for a hernia, then another imaging tool should be pursued.