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Best Imaging for Diagnosis
Thanks for this forum. Considering travel to another state for diagnosis of pain. Would like to know the best imaging to get prior to travel or remote consult with surgeon. Issue is tenderness and pain over right inguinal area for last four years, extending sometimes into groin area. Inguinal hernia repair with light mesh was done 5 years ago. Also a new symptom of frequent shock of pain in that area, concerned that it might be nerve irritation, but seems strange that It starts now. Suggestions appreciated, I realize that imaging is only part of the diagnosis. It is a start though.
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4 Replies
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If mesh is involved, MRI is the best study, as it shows the mesh and other details best.
If no mesh, than a well-performed hernia ultrasound with valsalva and maneuvers is adequate.
In my practice, I determine the radiologic study necessary after examining the patient, IF they never had surgery before. If they did have a repair, then I rely on MRI pelvis. That said, I read my own images, as the majority of the reports are misread for hernias. We have published about this problem (https://www.ncbi.nlm.nih.gov/pubmed/25141884) and recently updated our data, hopefully to be published this year.
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Some of my posts are being flagged or not posting so perhaps they occasionally mix-up, and some of them were crossed with other posts? Could be a glitch in the forum? Long ago I had another username (Chaunce12?) but the password was lost when they changed the forum. But alas no, I am not a doctor… though sometimes I feel like my knowledge level on certain topics is approaching that of some doctors… ha.
Anyway, I agree and have found the same thing regarding images, and heard many similar stories. Many doctors don’t read the images as they can be fairly complex, they often just read the paper report. Sometimes nowadays the radiologist is off-site or even outsourced to another country entirely, which is quite removed from the patient and it makes you wonder if anything gets lost in that process… thus whenever possible, try to have a specialist look at the actual images, as they may see things the radiologist didn’t, or that aren’t mentioned in the report itself.
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quote Chaunce1234:I’m a fellow patient, not a doctor. But…
Somehow I had got the impression that Chaunce1234 was Dr. David Earle. Maybe somebody else got that impression because some of your previous posts were signed off as “DE”. I haven’t found any posts where you describe your problem or procedure. Could you clarify? Thanks. I’ve only seen three surgeons post on this forum, and only two, Dr.Towfigh and Dr. Procter, post often, even though seven are listed. I wish that more of them would post more often.
To SpringsMan – I’ve found that many surgeons don’t read images themselves. They are interpreted at the facility where the images were taken, by a specialist in imaging, and a report is written. Typically, the specialist will look for signs of whatever the cause given is for the purpose of the image. And mesh does not show clearly on most imaging methods, so imaging is often not very useful. “No recurrence” is a common conclusion from imaging, which is meaningful but often already known. In short, you might want to pick a doctor first, and see what they recommend.
Can you give more detail on your procedure? Open, lap, mesh brand, direct or indirect, etc? A general location might get some recommendations also, for a good doctor.
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I’m a fellow patient, not a doctor. But…
– Ultrasound of groin with valsava, at the location of pain can often be very helpful in diagnosing hernias or recurrences.
– MRI of the pelvis (sometimes with valsava too) can also often reveal hernias or other potential causes of pain.
Does anything in particular help, or make the pain worse? Have you visited a pain clinic? Have you had nerve blocks or any other similar treatment before?
Where are you located? Perhaps someone on this forum can recommend a few hernia experts near you.
Best of luck, keep us updated on your case and progress.
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