KEY FACTS
Terminology
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Hernia: Weakness or defect in fibromuscular wall with protrusion of organ or tissue through defect
Imaging
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Midline hernias
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Epigastric: Between xiphisternum and umbilicus
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Umbilical: Umbilical or immediate paraumbilical region
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Hypogastric: Between umbilicus and pubic symphysis
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Lateral hernias
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Spigelian
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Lumbar: Occur in 2 potentially weak areas of flank
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Incisional hernia: Located at surgical incisional site
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Ultrasound 1st-line imaging for smaller hernias or children
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Dynamic, real-time examination; using maneuvers such as Valsalva or standing position to improve detection
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CT for larger, deep-seated hernias and complications and obese patients
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Localize site/size of abdominal wall defect and content
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Bowel: “Target” echo pattern with visible peristalsis
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Omental fat: Echogenic/hypoechoic nonperistalsing
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Document with cine clips
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Complications: Incarceration, strangulation, bowel obstruction
Top Differential Diagnoses
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Abdominal wall tumor
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Abdominal wall abscess or seroma
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Abdominal wall or rectus sheath hematoma
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Divarication (diastasis) of rectus abdominis muscles
Clinical Issues
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Most common abdominal wall lesion seen in ultrasound practice; discomfort, pain, intermittent intestinal obstruction
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Reducible/enlarging abdominal wall swelling
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20% require emergency repair for incarceration and strangulation
Scanning Tips
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High-resolution linear transducer for abdominal wall; curvilinear lower frequency and extended field of view (panoramic) for diastasis recti/large hernias/overview
arising from around the umbilicus. The locations of epigastric 
, spigelian 
, and hypogastric 
hernias are also shown for reference.
at the superior aspect of the umbilicus.
protrudes through a narrow defect 
in the linea alba, accentuated by the Valsalva maneuver.
with a small defect 
. No color flow is seen in the herniated omentum 
, not necessarily indicative of strangulation, as fat is usually hypovascular.
containing ascites, which protrudes through a defect in the linea alba at the umbilicus 
. No bowel is seen in the hernia.
is shown. Due to its size, the hernia was imaged with a curvilinear transducer. The defect in the abdominal wall is still visualized 
.
