What tests are useful for a hernia ?
Interestingly in 2018 not too many tests are needed to diagnose a hernia. Most hernia can be seen or felt. There may be a lump. A paplable 'impulse' can usually be felt when coughing as the hernia bulges out.
Hernia can usually be diagnosed by simple history and old fashioned examination. Your doctor may be very confident of the diagnosis. Don't be surprised if no special tests are ordered.
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However there may be doubt about an early or small hernia and a scan may be needed. For example, groin hernia are often bilateral as the weakness is symetrical. An USD can look at the other side to see if there is a weakness or small hernia which should also be repaired.
What about an Ultrasound ?
An USD is the best single test if one is needed. It is a movie and can see stuff moving in and out of the hernia defect. It can tell if the hernia is reducible. The sonograher will place the probe over your hernia and get you to cough and perhaps stand. No needles so a great test. However an USD can be hard to interpret. The skill of the sonographer is very important.
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An USD can readily detect a lipoma of the testicular cord in the groin. This can be mistaken for a hernia.
However USD is so good that it can often see small defects that are not a problem and may never become a problem. This can cause anxiety for the patient and the doctor. Just because an USD reports a hernia does not mean that it is significant.
Should I have a CT / MRI Scan ?
CT scans are great for all sorts of things including hernia. They are useful for complex post op incisional hernia as the individual muscle wall layers can be seen. A CT will show what is inside the hernia.
But they tend to be over used and should only be done for complicated hernia. A contrast CT requires a lot of radiation exposure (greater than 200 chest xrays) and is not routinely needed.
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An MRI is particularly good at helping sort out a groin strain injuries from a true hernia. It can show oedema and swelling at tendon attachments to the bone and can show muscle and tendon tears.
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