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Published on: February 2, 2015
The challenging sonographic inguinal canal evaluation in neonates and children: an update of differential diagnoses
Yoshino T Sameshima1, Maurício G I Yamanari2, Mariana A Silva2
1Diagnostic Imaging Department, Hospital Israelita Albert Einstein, Av. Albert Einstein, 627/701, 05651-901, São Paulo, SP, Brazil. kymjr@uol.com.br.
Insights
This review updates sonographic findings for pediatric inguinal canal disorders, focusing on processus vaginalis abnormalities like hydroceles and hernias. Accurate classification aids timely surgical intervention for these common pediatric conditions.
Area of Science:
- Pediatric Radiology
- Medical Imaging
- Ultrasound Diagnostics
Background:
- Inguinal region bulging is common in children.
- Sonographic evaluation of the pediatric inguinal canal presents diagnostic challenges.
- Processus vaginalis abnormalities are frequent causes of inguinal complaints.
Purpose of the Study:
- To update sonographic findings for common pediatric inguinal canal disorders.
- To focus on processus vaginalis abnormalities including hydroceles, hernias, and cryptorchidism.
- To aid radiologists in diagnosing complex inguinal canal ultrasound cases.
Main Methods:
- Systematic review of sonographic findings.
- Case illustrations from a 7-year quaternary hospital experience.
- Organization based on embryological, anatomical, and pathophysiological principles.
Main Results:
- Detailed sonographic criteria for congenital hydroceles and indirect inguinal hernias.
- Emphasis on differentiating types of hydrocele and hernia for surgical planning.
- Inclusion of rare diagnoses like abdominoscrotal hydrocele and canal of Nuck hernias.
Conclusions:
- Accurate sonographic classification of pediatric inguinal abnormalities is crucial.
- Early surgical intervention is facilitated by precise diagnosis.
- This review serves as a guide for complex inguinal canal ultrasound evaluations in children.
Abstract:
Bulging of the inguinal region is a frequent complaint in the pediatric population and sonographic findings can be challenging for radiologists. In this review we update the sonographic findings of the most common disorders that affect the inguinal canal in neonates and children, with a focus on the processus vaginalis abnormalities such as congenital hydroceles, indirect inguinal hernias and cryptorchidism, illustrated with cases collected at a quaternary hospital during a 7-year period. We emphasize the importance of correctly classifying different types of congenital hydrocele and inguinal hernia to allow for early surgical intervention when necessary. We have systematically organized and illustrated all types of congenital hydrocele and inguinal hernias based on embryological, anatomical and pathophysiological findings to assist readers in the diagnosis of even complex cases of inguinal canal ultrasound evaluation in neonates and children. We also present rare diagnoses such as the abdominoscrotal hydrocele and the herniation of uterus and ovaries into the canal of Nuck.
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