Recommended Format for Inguinal Hernia Ultrasound (USG) Structured Report
A comprehensive structured report format for inguinal hernia ultrasound should include administrative information, patient demographics, hernia characteristics, anatomical details, and management recommendations to ensure standardized documentation and facilitate optimal patient care. 1
Administrative Information
- Laboratory/facility name and location
- Date and time of examination
- Date and time of report finalization
- Accreditation status
- Study identifier/accession number
- Names and credentials of technicians and interpreting physicians
Patient Demographics
- Full name
- Medical record number
- Date of birth
- Gender
- Relevant prior imaging studies
Study Referral Data
- Referring physician information
- Clinical indication/question
- Study priority (routine, urgent, stat)
Patient History and Risk Factors
- Relevant medical history
- Previous hernia repairs or abdominal surgeries
- Presenting symptoms (pain, bulge, reducibility)
- Duration of symptoms
- Aggravating factors
Study Description
- Technical specifications of image acquisition
- Patient position during examination (supine, standing)
- Use of Valsalva maneuver or other dynamic techniques
- Overall study quality and limitations
Study Findings
Hernia Characteristics
- Presence or absence of hernia
- Type of hernia:
- Indirect inguinal (lateral to inferior epigastric vessels)
- Direct inguinal (medial to inferior epigastric vessels)
- Femoral (inferior to inguinal ligament)
- Size of hernia defect in two perpendicular planes (cm)
- Classification according to European Hernia Society: 1
- Location: Lateral (L)/Medial (M)/Femoral (F)
- Size: 1 (<1.5 cm), 2 (1.5-3 cm), 3 (>3 cm)
Hernia Contents
- Description of herniated structures (omentum, bowel, etc.)
- Presence of bowel peristalsis if applicable
- Signs of incarceration or strangulation:
- Bowel wall thickening
- Absent peristalsis
- Free fluid within hernia sac
- Hyperemia on Doppler evaluation
Anatomical Details
- Integrity of inguinal canal
- Relationship to inferior epigastric vessels
- Relationship to pubic tubercle
- Description of inguinal ligament
- Status of internal and external rings
Dynamic Assessment
- Reducibility of hernia (reducible, partially reducible, irreducible)
- Changes with Valsalva maneuver or standing position
- Presence of cough impulse
Comparison with Prior Studies
- Changes from previous examinations if available
- Progression or regression of hernia
Impression and Recommendations
- Clear answer to the clinical question
- Definitive diagnosis or differential diagnoses
- Recommendations for further imaging if needed
- Suggestions for clinical management when appropriate
Common Pitfalls to Avoid
- Failing to distinguish between direct and indirect hernias
- Overlooking femoral hernias, especially in female patients
- Incomplete documentation of hernia size and reducibility
- Not performing dynamic assessment with Valsalva maneuver 1
By following this structured format, clinicians can ensure comprehensive documentation of inguinal hernias, facilitating standardized care, quality assessment, and improved patient outcomes 2. The use of ultrasonography as an adjunct to physical examination improves diagnostic accuracy, particularly in challenging cases such as obese patients, women, and suspected recurrent hernias 3.