title: Role of imaging in the diagnosis of occult hernias.
abstract: OBJECTIVE
  Occult hernias are symptomatic but not palpable on physical examination. This is more commonly seen with inguinal hernias. Early diagnosis and treatment of occult hernias are essential in relieving symptoms and improving patients' quality of life.
  
  
  OBJECTIVE
  To determine the effectiveness of imaging-ultrasonography (US), computed tomography (CT), and magnetic resonance imaging (MRI)--in the diagnosis of occult inguinal hernia.
  
  
  METHODS
  A retrospective medical records review of surgical patients with groin and pelvic pain, 2008-2013, was conducted in a single-surgeon hernia specialty practice. Thirty-six patients met the following inclusion criteria: (1) examination findings suggestive of but not necessarily diagnostic for inguinal hernia; (2) imaging of the groin and/or pelvis with US, CT, and MRI; and (3) an operation to address the groin or pelvic pain. Fifty-nine groins were included.
  
  
  METHODS
  Sensitivity, specificity, and predictive values of US, CT, and MRI for detection of occult inguinal hernia.
  
  
  RESULTS
  The number, sensitivity, specificity, positive predictive value, and negative predictive value of each modality were, respectively: US (9, 0.33, 0, 1.00, and 0), CT (39, 0.54, 0.25, 0.86, and 0.06), and MRI (34, 0.91, 0.92, 0.95, and 0.85). Among multiply imaged groins in which CT examination missed a diagnosis of hernia, MRI correctly detected an occult hernia in 10 of 11 cases (91%).
  
  
  CONCLUSIONS
  Ultrasonography and CT cannot reliably exclude occult groin abnormalities. Patients with clinical suspicion of inguinal hernia should undergo MRI as the definitive radiologic examination.
authors.affiliation: Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, California.
authors.forename: Joseph
authors.initials: J
authors.lastname: Miller
authors.affiliation: student, Pitzer College, Claremont, California.
authors.forename: Janice
authors.initials: J
authors.lastname: Cho
authors.affiliation: student, The George Washington School of Medicine and Health Sciences, Washington, DC.
authors.forename: Meina Joseph
authors.initials: MJ
authors.lastname: Michael
authors.affiliation: Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, California.
authors.forename: Rola
authors.initials: R
authors.lastname: Saouaf
authors.affiliation: Beverly Hills Hernia Center, Beverly Hills, California.
authors.forename: Shirin
authors.initials: S
authors.lastname: Towfigh
mesh_terms: D003937:Diagnosis, Differential; D003952:Diagnostic Imaging; D005260:Female; D006552:Hernia, Inguinal / Q000175:diagnosis*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D010147:Pain Measurement; D017699:Pelvic Pain / Q000175:diagnosis; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography