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Musculoskeletal » Superficial

Nonreducible inguinal hernia containing the right ovary

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Author(s) :

Taco Geertsma, MD

Presentation Four weeks old girl with a palpable mass in the right groin

Caption: Detail of the palpable mass

Description: The image shows a solid lesion with tiny cystic structures. The small cysts are the follicles in a normal ovary

Caption: Longitudinal view of the groin

Description: This longitudinal view of the groin shows an intrabdominal extension of the lesion consistent with an inguinal hernia

Caption: Transverse view of the groin

Description: The Transverse view of the groin shows an intrabdominal extension of the lesion consistent with an inguinal hernia

Caption: Color Doppler image of the lesion

Description: This color doppler image shows the normal vascularity of the right ovary

Caption: Transverse image with color Doppler of the lesion

Description: This color doppler image shows the normal vascularity of the right ovary. Also flow in the epigastric artery and vein (round vessels) can be identified. The vessels entering the hernia run lateral to the epigastric vessels. This means it is a lateral or indirect inguinal hernia

Differential Diagnosis Differential diagnosis of a palpable mass in girls are
- Nuck cyst or hydrocele.
- Inguinal lymphe node
- Inguinal hernia.
- Soft tissue tumors

Final Diagnosis nonreducible inguinal hernia containing the right ovary

Discussion

A Nuck cyst or hydrocele is a cystic non vascularized lesion in a typical location.

Inguinal lymphe nodes are solid structures although necrosis or abscess formation can result in cystic areas. They are often multiple and show no intra abdominal extension.

Inguinal hernia. Inguinal hernias can be differtiated accordind to
Location: in a medial (direct) or lateral (indirect ) inguinal hernia
Effect of compression: Reducible or nonreducible inguinal hernia
Contents: Fluid, fat bowel ovary or other abdominal structures

Other soft tissue tumors benign (like lipomas) or malignat (like sarcomas) in a very young girl are rare but must be considered in any case of a solid mass. In some cases necrosis in a tumor can mimick a cystic lesion.
For more examples of inguinal hernias visit http://www.ultrasoundcases.info

Case References

Narci A, Korkmaz M, Albayrak R, Sözübir S, Güvenç BH, Köken R, Demir T, Dogru O. Preoperative sonography of nonreducible inguinal masses in girls.J Clin Ultrasound. 2008 May 27;36(7):409-412.

Huang CS, Luo CC, Chao HC, Chu SM, Yu YJ, Yen JB. The presentation of asymptomatic palpable movable mass in female inguinal hernia.Eur J Pediatr. 2003 Jul;162(7-8):493-5.

Follow Up The patient was operated and the diagnosis was confirmed

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