Study Group #1 in series: Breaking Down the Wall: US of Abd Wall & Hernias: From Anatomy to Case Rvw

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CME available for this session = 1

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• Members: FREE
• Non-members: $10

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Title of Presentation: Breaking Down the Wall: Ultrasound of Abdominal Wall & Hernias: From Anatomy to Case Review
Randy Gay, MAS, RDMS (AB, OB/Gyn) – Clinical Instructor (University of North Carolina at Chapel Hill)

Learning Objectives
1. Review abdominal wall anatomy and physiology

• Layers of the abdominal wall (skin, subcutaneous fat, muscles, fascia, peritoneum).
• Normal physiologic functions (support, pressure regulation, movement).

2. Identify the sonographic appearance of abdominal wall structures

• Normal grayscale appearance of muscle, fat, fascia, and peritoneum.
• Some scanning pitfalls.
• Review Doppler utility for vascular landmarks.

3. Discuss and define common abdominal wall pathologies

• Hernias (inguinal, umbilical, incisional, Spigelian, femoral).
• Differentiating reducible vs. incarcerated/strangulated hernias.
• Other pathology: hematoma, abscess, neoplasm, postoperative changes.

4. Apply knowledge through case studies and image review

• Real-world cases with images and video clips.
• Correlation with clinical signs and surgical implications.

Presentation Plan (55–60 minutes)
1. Introduction & Learning Objectives (3–5 min)

• Why abdominal wall/hernia evaluation matters in ultrasound practice.
• Quick outline of session flow.

2. Anatomy & Physiology Review (10–12 min)

• Abdominal wall layers (skin → subcutaneous fat → muscle layers → fascia → peritoneum).
• Key vascular landmarks (epigastric vessels, inguinal canal).
• Functions of the abdominal wall (support, intra-abdominal pressure, respiration).

3. Sonographic Appearance of Abdominal Wall Structures (10–12 min)

• Normal sonographic patterns (muscle striations, fascia echogenicity, fat echogenicity).
• Probe selection and frequency (high-frequency linear vs. curvilinear for deeper evaluation).
• Patient maneuvers: Valsalva, standing vs. supine, dynamic scanning. 
• Show 2–3 normal clips

4. Pathology: Common Hernias & Abdominal Wall Conditions (15–18 min)

• Types of hernias:
  • Inguinal (direct vs indirect)
  • Umbilical
  • Spigelian
  • Femoral
  • Incisional/postoperative
• Sonographic signs:
  • Hernia sac, neck, reducibility, peristalsis, vascular compromise.
• Other pathology:
  • Abdominal wall hematoma, abscess, seroma, desmoid tumors, lipomas.

5. Case Studies & Case Reviews (12–15 min)

• Present 4–5 cases (static images + cine clips if available).
• Structure for each:
  • Brief patient history. 
  • Show images with and without labels
  • Walk through key sonographic findings.
  • Correlate with diagnosis and management.

6. Wrap-Up & Q&A (5 min)

• Recap main teaching points:

1. Know your anatomy.
2. Use dynamic maneuvers.
3. Recognize key hernia patterns and pathology.

Target audience:

• Early career professional sonographers
• Students currently enrolled in sonography program
• Sonographers who may be working in departments without a standardized protocol for abdominal wall or hernia evaluations.