Initial Radiographs May Be Inaccurate in Patients With Occult Inguinal Hernia

Albert B. Lowenfels, MD


January 11, 2019

Do radiology reports help diagnose a patient with what may be an occult groin hernia? A recent study performed at a hernia referral center provides data from patients referred to the center who had groin pain but no visible lump.[1] Published in the Journal of the American College of Surgeons, this study is based on information from 125 groins, where surgical findings after groin surgery were compared with the original radiology reports (either CT or MRI studies) from the initial referring center.

At the time of surgical exploration, a groin hernia was noted in 112 of 125 (90%) patients. The original radiology reports, when compared with the operative findings, were unreliable: The positive predictive value was 97%, but the negative predictive value was only 13%.

Be Wary: Initial Negative Radiology Reports Are Unreliable

Managing a patient with complaints of groin pain without a detectable lump can be a vexing problem for both the patient and the surgeon. In an effort to clarify the underlying cause, many patients undergo one or more radiologic procedures. This study tells us to be wary of negative reports because they are unreliable. Surprisingly, even though the initial request to the radiologist was to evaluate the cause of groin pain, more than half of the final reports did not mention the groin.

Having the original report reviewed by a second radiologist at the hernia center increased the overall accuracy, but the negative predictive value was still 30%. As in other studies, MRI reports proved to be more accurate than CT reports. The authors concluded that a positive radiology report should be trusted, but a patient could still have a groin hernia even when the report is negative.

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