title: Ultrasound of the Groin: Techniques, Pathology, and Pitfalls.
abstract: OBJECTIVE
  In a patient with symptoms referable to the groin, there can be a number of causes to consider and at times the cause of the symptoms is multifactorial. Although ultrasound can be effective in the evaluation of the groin, the depth and complexity of the anatomy can be problematic. A protocol-driven approach for ultrasound evaluation of the groin will help to ensure an accurate and comprehensive evaluation. This article summarizes the ultrasound technique and protocol for evaluation of the groin to include evaluation of the hip joint, anterior hip musculature, the iliopsoas bursa, the inguinal lymph nodes, the pubic symphyseal region, and the inguinal region for hernias. Common pathologic conditions and pitfalls related to ultrasound evaluation of the groin will be reviewed.
  
  
  CONCLUSIONS
  There are many potential pathologic conditions in a patient with groin symptoms. Because symptoms may be multifactorial and history may be ambiguous or misleading, a protocol-driven evaluation with ultrasound is recommended. The hip joint is evaluated for effusion, synovitis, and labral abnormalities. The muscles and tendons, including the common aponeurosis at the pubic symphysis, are evaluated for tendinosis and tears. Dynamic evaluation should be considered to assess for snapping hip syndrome. Iliopsoas bursal distention and lymph node enlargement are other considerations. Last, inguinal region hernias must be evaluated during the Valsalva maneuver and documented in two orthogonal planes to avoid several important diagnostic pitfalls.
authors.affiliation: 1 Department of Radiology, University of Michigan, 1500 E Medical Center Dr, TC-2910L, Ann Arbor, MI 48109-0326.
authors.forename: Jon A
authors.initials: JA
authors.lastname: Jacobson
authors.affiliation: 2 Department of Radiology, University of Pennsylvania, Philadelphia, PA.
authors.forename: Viviane
authors.initials: V
authors.lastname: Khoury
authors.affiliation: 1 Department of Radiology, University of Michigan, 1500 E Medical Center Dr, TC-2910L, Ann Arbor, MI 48109-0326.
authors.forename: Catherine J
authors.initials: CJ
authors.lastname: Brandon
mesh_terms: D006119:Groin / Q000000981:diagnostic imaging*; D006552:Hernia, Inguinal / Q000000981:diagnostic imaging; D006801:Humans; D008198:Lymph Nodes / Q000000981:diagnostic imaging; D009140:Musculoskeletal Diseases / Q000000981:diagnostic imaging; D011631:Pubic Symphysis / Q000000981:diagnostic imaging; D014463:Ultrasonography
keywords: groin; hernia; hip; joint; ultrasound