Imaging of Groin Masses: Inguinal Anatomy and Pathologic Conditions Revisited

Abstract

The groin region is subdivided into two distinct anatomic areas: the inguinal canal and the femoral triangle. A series of cross-sectional imaging cases illustrate that a good understanding of the local anatomic characteristics of the groin allows confident characterization of groin pathologic conditions. Such conditions can be classified into five major groups: congenital abnormalities, noncongenital hernias, vascular conditions, infectious or inflammatory processes, and neoplasms. Congenital entities include hernias, cysts, undescended testis, and retractile testes. Ultrasound (US) is useful in depicting these conditions. In the second group, noncongenital hernias, US allows visualization of bowel loops in peristalsis within the hernia. Herniography, computed tomography (CT), and magnetic resonance (MR) imaging are also helpful in diagnosis. Among vascular conditions, false aneurysms may be detected from the turbulent flow through the tract at Doppler US. The characteristic venous flow of varicoceles is best diagnosed with US during the Valsalva maneuver. Infectious or inflammatory conditions include, among others, hematomas, which appear hyperattenuating at CT and have variable appearances, depending on the age of the blood products, at MR imaging. The origins of neoplasms may be assessed at CT and MR imaging, although appearances of solid tumors are relatively nonspecific.

Canal of Nuck Hernia in a Female Infant Containing Uterus, Bilateral Adnexa and Bowel

“…Embryologically, inguinal canal development necessities anatomic events involving two main anatomic structures, the gubernaculum testis and processus vaginalis (4,5). The gubernaculum testis attaches to the skin of the fetal groin inferiorly and to the lower pole of the fetal gonad superiorly.…”

“…The processus vaginalis (called the canal of Nuck in the female) is a tubular fold of peritoneum that invaginates into the inguinal canal. The upper part of the canal of Nuck usually closes at or just before birth, and obliteration proceeds gradually in a downward direction (4). If the canal of Nuck remains open, bowel loops and ovary can herniate through the inguinal canal into the labia majora in female infants.…”

“…The uterus is an elongated structure with myometrium and endometrium. To exclude strangulation and incarceration, color and pulsed Doppler evaluation is helpful (4).…”

A Painful Groin Pseudotumor Mimicked an Incarcerated Hernia

“…US scans reveal a diverse pattern of echogenicity, and CT scans may also reveal variable density or contrastenhanced images of the lesion [22]. Moreover, magnetic resonance imaging usually has low signals on T1-and T2-weighted images, and these characteristic are related to IPT fibrosis [8,24,25]. Conclusive clinical and radiological diagnosis is nearly impossible because these lesions can mimic many kinds of diseases like malignant tumors.…”

Region Inguinal: Ultrasonografia

“…De esta forma sigue un curso oblicuo descendente desde lateral a medial dejando claramente dos espacios bien definidos. Por encima de su mitad inferior el conducto inguinal y por debajo el canal femoral que a su vez se divide en dos compartimentos o lagunas a) La laguna muscular lateral y superior y b) La laguna vascular medial e inferior (4,5). I.-Conducto inguinal.…”