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

  Posted by wth on October 6, 2019 at 7:26 pm

  Hello,

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

  And reading this study by Dr Towfigh
  https://jamanetwork.com/journals/jamasurgery/fullarticle/1893806

  It 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

  So I’m currently at MRI stage of the algorithm:

  High clinical suspicion of inguinal hernia => Non diagnostic examination (possible hidden hernia?) => Ultrasonography or CT => Negative => MRI

  and have an MRI scheduled for Saturday:

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

  Is MR of the abdominal and pelvis should be enough to the detect the hidden hernia? Because the study also talks about groin pain, so I wonder if I need a separate MRI of the groin, or the pelvis already includes the groin region as well?

  Also the study mentions, how a CT can miss a hidden hernia:
  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 then an MRI can see it:
  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 this study to the radiologist and ask him to try to get a similar angle shot of: “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 any pain during when I went to get the ultrasound and CT because I was trying to keep the pain at bay by avoiding any physical activities that would trigger it, would it be a good idea to activate the pain for example a day before, like playing table tennis, so when I come to do the test, they should be able to see the source to the pain in the imaging, i.e. Maybe when the pain gets activated, it creates an indirect sack of fluids, that might put pressure on nerves and sperm cords, that will only be visible in the MRI?

  I really want to get a diagnosis for this problem I’m experiencing now for 4 months. I think the communication with the radiologist is very crucial, so any advice would appreciated.

  Thanks!

  wth replied 5 years, 5 months ago 1 Member · 0 Replies
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