• How to instruct/assist the radiologist to look for occult hernia in the MRI?

  Posted by wth on October 6, 2019 at 8:52 pm

  Hello,

  Following up on my introductory thread:
  https://www.herniatalk.com/12969-what-can-cause-lower-abdominal-pain-triggered-by-certain-physical-movements

  This study made by Dr Towfigh:
  https://jamanetwork.com/journals/jamasurgery/fullarticle/1893806

  Mentions the treatment algorithm:
  https://cdn.jamanetwork.com/ama/content_public/journal/surg/930960/soi140032f3.png?Expires=2147483647&Signature=0-tVhc7RyJmPM-CNZfzcHb-7mCI64qUVrKuQOjZ2qtcpwiUa2sx28nVCIlkBONsi5wxP4f5G1I~x2TK54TTnuWTvRVN5UGpfSAXWFS0zckmiD5qsJzaJHvKFILWm-vNMP~QyqubCkXw65~GBCEmw0l9WxSyUy~gcbmX-LHzyfvzYa28HLap-~~Fl7Fu931h~NcD8PC-r53k-GjhKijQ5VQrD0Mwgp-N9T1vWX-n0QXznvMyzr9kciox5fSbZazpCRNztlNm7G-UFFi9Tmm78IMvVlQhUeMQFmhG1G6N-gOW~nZwW8XPm3cWEwR0IA58g3aYtY8qISE2CiNKQxOt55g__&Key-Pair-Id=APKAIE5G5CRDK6RD3PGA

  I’m currently at the MRI stage:

  High clinical suspicion for inguinal hernia => Nondiagnostic examination (possible hidden hernia?) => Ultrasonography or CT => Negative => MRI

  So I got an MRI scheduled on Saturday:

  *MRI Abdomen with and without contrast
  *MRI Pelvis with and without contrast

  Is MRI of the abdominal and pelvis should be enough to diagnose a hidden hernia? Because the study mentions groin pain, so I wonder if I also need a separate MRI of the groin or it’s already included in the MRI of the pelvis?

  Study mentions that a hidden hernia can be missed by a CT scan:
  https://cdn.jamanetwork.com/ama/content_public/journal/surg/930960/soi140032f1.png?Expires=2147483647&Signature=fLYlRcgoFhc4nuIuS6il8hd5KO5rG2XEwRntgwFm2yHVDVdXmzB8IGGqy~6~mxWx7G5urq6O~Ge5WBRRy2p8vcPinBowFpwGsfEfmVn8hf38Ct9L8~7HKK2OdMv2EIrxp9G~yoGLUbmsjECrcqqxGyp6whd8Nhjf1UVBrtbLelxzutTbEjhPAnb7dOXJSF-XpFx-31ovFUNZ8Pavk~hdQBTaV7lHnBa5WUpx8Ftq1gEZ~Fmn5mlL95WYeWKjwlxDsWycr0iAH7pIWd6lG9EDFKZS5~0Vh60YYC-ndvWg-GfiyYSbofV1CT5LQml3oID7Sq3ENM4CicVoVr3CW~CVrA__&Key-Pair-Id=APKAIE5G5CRDK6RD3PGA

  “Nondiagnostic Computed Tomography (CT)

  Axial CT through the pelvis is nondiagnostic for an operatively confirmed right inguinal hernia.”

  But can be seen by an MRI:
  https://cdn.jamanetwork.com/ama/content_public/journal/surg/930960/soi140032f2.png?Expires=2147483647&Signature=37hWTmwKTNpNYJhOaWDaHsMjTXYcfCP-lgbB-zL1TYocfS8Lnuj-v-uoiQEk~5EV5nEsKD8IuP~d95clG~ARydAcKF72PzZn7Y9CPKqJaPlNIJjUKg0~Oo51aALvcThfX4pfDqZn8wff9I~jiH-szGfNaF5n5fWwsLQkoE4AtrA97wKKoSiLCTujSyiTfaiIwdXy68orLYoNm9a8GoObik92cdVKAwwEQMjQsD7SyKdTnCv4A0nA3vvfwcn5p8XHcqLKdsr9-w~uYiDN8klVhvNmQiYeZfpwpnpyb1fWjF96Gc7qLmhskKxSiYgq8axw-sjk-2eiVrXNkl9DMbsJsQ__&Key-Pair-Id=APKAIE5G5CRDK6RD3PGA

  “Diagnostic Magnetic Resonance Imaging (MRI)

  Axial (A), sagittal (B), and coronal (C) T2 half-Fourier acquisition single-shot turbo spin-echo (HASTE) MRI through the pelvis in the same patient reveals right inguinal hernia (arrowheads).”

  So should I show the radiologist this study, and ask him to try to make a similar angle shot as described here: “Axial (A), sagittal (B), and coronal (C) T2 half-Fourier acquisition single-shot turbo spin-echo (HASTE) MRI through the pelvis in the same patient reveals right inguinal hernia (arrowheads).”?

  Also, given that I didn’t have pain when I got the ultrasound and CT scan, because I was keeping the pain at bay by avoiding physical activities that trigger it, should I activate the pain like a day before (i.e. by doing some physical activity like playing table tennis), so that way, when I come to do the test, they will able to find the source to the my pain? Perhaps by seeing some indirect sack of fluids generated by the hernia that only the MRI could see?

  I really want to find a diagnosis to my pain that I’ve been experiencing for the last 4 months, and I think that communication with the radiologist is very important, so any advice would be appreciated.

  Thank you!

  wth replied 5 years ago 1 Member · 0 Replies
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