News Feed Discussions MRI with valsava for imaging & diagnosing hernia?

  • MRI with valsava for imaging & diagnosing hernia?

    Posted by RJ on January 26, 2015 at 9:53 pm

    Hello Dr Towfigh. I’m a 32 year old male with left groin / inguinal pain, perhaps coincidentally I also have a small (5mm) left-side femoral hernia that was recently found with an Ultrasound, but doctors are not convinced the symptoms and discomfort I experience match the clinical findings.

    Anyway, I will be getting a pelvic MRI with Valsava (including valsava by request after reading here) soon to help determine what is going on with the area, but I want to be sure the imaging is performed properly to get the best results. Are there any specifics to request with an MRI with valsalva to properly image small and hidden hernias? Is contrast necessary for this test, and should contrast be included to determine if there are other potential findings? Is there any specific variation of MRI or MRI machine to request or are they all the same? Do we as patients just take a deep breath and strain down repeatedly for 45 minutes? I assume since this seems like a fairly unique imaging study that there may be some specifics for best results. Aside from that I figure the general MRI question will probably be relevant to some others out there in similar situations with mysterious regional pain.

    Any information with understanding the proper MRI procedure to image and diagnose potential pelvic / groin hernias and/or other causes of groin and pelvic pain would be greatly appreciated! Thanks in advance.

    LindaS replied 7 years, 5 months ago 3 Members · 6 Replies
  • 6 Replies
  • drtowfigh

    Moderator
    October 1, 2016 at 5:31 pm

    MRI with valsava for imaging & diagnosing hernia?

    Hi LindaS
    Any updates?

  • LindaS

    Member
    June 3, 2016 at 1:59 pm

    MRI with valsava for imaging & diagnosing hernia?

    Thank you for your input on the imaging. I am trying to get to the correct diagnosis for my pain and this information will help me in my upcoming appt.

  • RJ

    Member
    February 13, 2015 at 8:26 pm

    MRI with valsava for imaging & diagnosing hernia?

    For anyone out there wondering what the actual test process of MRI with valsava is like, it is non-eventful. There is no prep. You lay down very still for about an hour and a half while wearing ear plugs, and the MRI itself sounds like exceptionally bad music. It feels a bit warm, but a fan is blowing on you. Towards the end of the MRI they instruct you when to do valsava, I did three sustained valsava sequences (take big breath, bear down) for about 10-15 seconds each, with a few minutes between them to relax. Doing a valsava while laying down is kind of challenging, but it works.

    The particular imaging center I went to said mine was the first MRI with valsava they had done, but they had experience doing CT with valsava before. It sounds to me like this is a relatively new technique for diagnostics, which I think it is clearly beneficial to patients, and I think for people with pelvic and/or groin pain with no obvious cause it could be quite helpful. I specifically mentioned the Imaging Occult Hernias JAMA study and research by Dr Towfigh to my doctor when discussing the MRI, and he was more than willing to give it a try. Here is the link to that JAMA research for those interested: http://archsurg.jamanetwork.com/article.aspx?articleid=1893806

  • RJ

    Member
    February 13, 2015 at 7:31 pm

    MRI with valsava for imaging & diagnosing hernia?

    Hi Dr Towfigh, thank you for the reply and additional information!

    A quick update: I had the MRI with valsava done and just got a call with results, the radiologist interpretation is a “small inguinal hernia that increases in size with valsava”, it is “fat containing” and “tip of bowel may be present during valsava”. There is also a “thickening or edema of the cord structures” – but they aren’t sure if that is related. I find that particularly interesting because the pain and discomfort I have often feels like a pinch in the left spermatic cord, sometimes radiating down and sometimes radiating up. I basically never have pain in the thigh, pain is almost always in the left groin, sometimes left testicle, and along the lower portion of the left inguinal region. Also curious to me is that no femoral hernia was visible on MRI, which was what an ultrasound had reported, I am not sure what to make of that. I do have an appointment with a surgeon in two weeks to hear additional details, and to see what their thoughts are. I don’t know if it matters, but I am thin / athletic with low body fat, and there is no palpable finding and nothing visible to the eye. Nonetheless, I am hoping for a match with the physical location of my pain and the physical location of the defect found on MRI – we’ll see if that is possible.

    Now this is just my personal opinion, but for anyone with pelvic or groin pain that has been an ongoing diagnostic mystery (it sounds like there are a fair amount of us out there!)… I would HIGHLY recommend having the MRI with valsava done, it may show information that has been missed or otherwise not seen, and it may lead to getting some answers.

    Anyway, I’ll continue to post updates as I get more information.

  • drtowfigh

    Moderator
    February 6, 2015 at 5:26 am

    MRI with valsava for imaging & diagnosing hernia?

    Here are details for best imaging for small or occult/hidden inguinal hernias:

    – non-contrast MRI pelvis. Nothing to drink. No injections.
    – 3Tesla machine is preferred. Some centers get good results with 1.5T but the tech must be very diligent there is minimal motion artifact, etc.
    – no open MRI. Won’t give you enough clarity of picture
    – Valsalva (bear down) is key to finding the very small ones.
    – they should mark the area of your pain
    – in my center, they also do dynamic video images. Doesn’t add much more to the Valsalva still images, frankly.
    – in my center, they also do close ups of the hip, which helps rule out a hip problem as the cause of groin pain.

    RJ: your symptoms can absolutely be due to a femoral hernia. Usually these present as groin pain that radiates down the top of the thigh. Not sure why an MRI is necessary when ultrasound already shows the femoral hernia. With laparoscopic repair (now gold standard for femorals), any other inguinal would be found and repaired anyway. Lastly, all femoral hernias should be repaired. They have a high rate of strangulation, unlike other inguinal hernias.

  • RJ

    Member
    February 5, 2015 at 7:08 pm

    MRI with valsava for imaging & diagnosing hernia?

    Just an update, I have an MRI pelvis with valsava (without contrast) scheduled.

    I can’t seem to find any reliable information on if contrast matters for imaging pelvic anatomy and pathology, so hopefully this will be an informative imaging modality without it.

    I will update with details when available.

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