Radiologic Reporting and Interpretation of Occult Inguinal Hernia

Inguinal hernias are common entities. Occult inguinal hernias are difficult to diagnose on examination and can cause groin and pelvic pain. Imaging is heavily relied on to help diagnose these hernias; as such, correct interpretation of imaging studies can prevent delay in treatment for a patient with pain. We evaluated the accuracy and reliability of radiologic reports for detection of occult inguinal hernias in patients with groin and pelvic pain.

All CT and MRI studies ordered for groin or pelvic pain during a 5-year period were analyzed. Studies were included if the original radiologic reports were available for review, and if the patient underwent operative exploration. A blinded radiologist was asked to "over-read" the images. Operative findings were considered the gold standard with which radiologic reports were compared.

Of 322 CT and MRI studies, 125 groins met criteria. Original radiologic reports were 35% accurate, with 97% positive predictive value (PPV) and 13% negative predictive value (NPV). Over-read radiologist reports were significantly different (p < 0.0001), with 79% accuracy, 97% PPV, and 30% NPV.

Most radiologic reports issued for CT and MRI studies were incorrect for evaluation of occult inguinal hernia. Over-read radiologist reports were more than twice as accurate when evaluating the same images. The physician who is relying on radiologic reports to determine plan of care for a patient with groin or pelvic pain should inquire further into any negative study, especially if there is strong clinical suspicion for inguinal hernia.