From the Guidelines
The best diagnostic test for a hernia is a CT scan, which has a sensitivity and specificity of 14–82% and 87%, respectively, making it the gold standard for diagnosing diaphragmatic hernia. When a physical examination is inconclusive, imaging studies are necessary to confirm the diagnosis. A chest X-ray can be useful, with a sensitivity of 2–60% for diagnosing left-sided hernia and 17–33% for right-sided hernia 1, but it may not be sufficient for complex cases.
- Key findings on a CT scan include diaphragmatic discontinuity, segmental non-recognition of the diaphragm, and the "Dangling diaphragm" sign, which can help determine the presence, location, and size of the diaphragmatic defect 1.
- CT scan is particularly useful in evaluating intrathoracic complications of herniated abdominal organs and can detect signs of ischemia, such as forward displacement of the gastric bubble and lack of enhancement after injection of iodinated contrast agent 1.
- While other imaging modalities like ultrasound and MRI may be used in specific cases, CT scan remains the most accurate and reliable diagnostic test for hernia, especially in complex cases or when complications are suspected 1.
From the Research
Diagnostic Testing for Hernia
The best diagnostic test for a hernia is often a combination of physical examination and imaging studies.
- Physical examination is usually sufficient to make the diagnosis, with symptomatic patients often experiencing groin pain, a burning or aching sensation, and a heavy or dragging sensation that worsens throughout the day 2, 3.
- Imaging studies such as ultrasonography, magnetic resonance imaging (MRI), or computerized tomography (CT) may be used to confirm the diagnosis, especially in cases where the physical examination is inconclusive or in athletes without a palpable impulse or bulge 2, 3, 4.
Imaging Modalities
- Ultrasonography is often the preferred imaging modality for diagnosing inguinal hernias, with high sensitivity and specificity 4.
- MRI has higher sensitivity and specificity than ultrasonography and is useful for diagnosing occult hernias if clinical suspicion is high despite negative ultrasound findings 3.
- CT scans may also be used, but are less commonly used for diagnosing inguinal hernias 4.
Physical Examination Techniques
- The inguinal occlusion test, combined with the use of a hand-held Doppler device, can be an accurate method for differentiating between direct and indirect inguinal hernias 5.
- A new method of physical examination that combines the inguinal occlusion test with a hand-held Doppler device has been shown to have high accuracy in distinguishing between direct and indirect inguinal hernias 5.
Special Considerations
- In athletes, the diagnosis of an inguinal hernia can be challenging, and a thorough physical examination and imaging studies may be necessary to confirm the diagnosis 6.
- The timing of surgery for an inguinal hernia depends on the severity of symptoms and the patient's overall health, and may be influenced by the patient's activity level and occupation 6.