Ultrasonography of inguinal hernia

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Author: Mikael Häggström [notes 1]

Indirect inguinal hernia (through the inguinal canal).


Indication for imaging

In strong abdominal pain, a suspected strangulated hernia indicates surgery without previous medical imaging.

A physician may diagnose an inguinal hernia, as well as the type, from medical history and physical examination.[1] Imaging is therefore indicated for confirmation or in uncertain cases.

Choice of modality

  • Ultrasonography of inguinal hernia is otherwise generally the initial choice of investigation, since it can diagnose the condition, in Valsalva maneuver and standing if necessary, as well as being able to determine the ability to reduce any hernias by pressure.[2]
  • Abdominal CT of inguinal hernia is indicated in unspecific abdominal symptoms, in order to better diagnose possible differential diagnoses.

How soon

In Swedish practice, ultrasonography of an inguinal bulge is performed within 2 months unless there is significant pain.[notes 2]


Ultrasound of an indirect hernia containing fat, with testicle seen at right.

Without and with Valsalva maneuver.[3] Preferably also in standing.[3] Look primarily for an increased diameter of the inguinal canal, which is normally 2 cm (±1 cm in standard deviation) at the deep inguinal ring.[notes 3][4]

Further workup if detected

If an inguinal hernia is detected:

  • Size with and without provocation (Valsalva maneuver and/or standing)
  • Content, merely fat, or also intestines
  • Ability to reduce by pressure

If the hernia is not clearly within the inguinal canal, check if it lies medially to the inferior epigastric vessels, since it is then classified as a direct hernia.

Further workup if NOT detected

If the pain location may suggest it, also consider performing an Ultrasonography of femoral hernia and/or Ultrasonography of hydronephrosis in the same session.


  1. For a full list of contributors, see article history. Creators of images are attributed at the image description pages, seen by clicking on the images. See Radlines:Authorship for details.
  2. NU Hospital Group, Sweden
  3. ±2.2cm ±1.08cm in Africans, and 2.1 cm 0.41 ±0.58cm in Europeans.


  1. LeBlanc, Kim Edward; LeBlanc, Leanne L; LeBlanc, Karl A (15 June 2013). "Inguinal hernias: diagnosis and management. ". American Family Physician 87 (12): 844–8. PMID 23939566. Archived from the original. . 
  2. Stavros, A. Thomas; Rapp, Cindy (September 2010). "Dynamic Ultrasound of Hernias of the Groin and Anterior Abdominal Wall ". Ultrasound Quarterly 26 (3): 135–169. doi:10.1097/RUQ.0b013e3181f0b23f. PMID 20823750. 
  3. 3.0 3.1 Jamadar, David A.; Jacobson, Jon A.; Morag, Yoav; Girish, Gandikota; Ebrahim, Farhad; Gest, Thomas; Franz, Michael (2006). "Sonography of Inguinal Region Hernias ". American Journal of Roentgenology 187 (1): 185–190. doi:10.2214/AJR.05.1813. ISSN 0361-803X. 
  4. Mitura, Kryspin; Kozieł, Sławomir; Pasierbek, Michał (2018). "Ethnicity-related differences in inguinal canal dimensions between African and Caucasian populations and their potential impact on the mesh size for open and laparoscopic groin hernia repair in low-resource countries in Africa ". Videosurgery and Other Miniinvasive Techniques 13 (1): 74–81. doi:10.5114/wiitm.2018.72579. ISSN 1895-4588.