0:00

Okay, because this is so important,

0:02

again, the groin hernias, you're going to draw

0:04

the horizontal line from the symphysis

0:06

pubis. Anterior is going to be your inguinal hernia.

0:09

Femoral hernias will be posterior, and your

0:12

obturators will be deep to the pectineus muscle.

0:14

Very uncommon, but a high mortality.

0:17

So we want to make that diagnosis.

0:19

Once you look at the femoral hernias, you want to

0:21

look for the femoral vein comma sign, which

0:23

is when the femoral vein is impacted, and you

0:26

want to note that it is anterior to the pectineus

0:28

muscle because that's your landmark between

0:30

the femoral hernia and the obturator hernia.

0:33

Let's look at this case quickly, just as kind of

0:35

an aside since I've had, um, this diagnosis done

0:38

wrong a number of times by individuals around me.

0:40

So here we have, in the left groin region,

0:44

we have fluid, fluid, fluid, fluid.

0:47

But this is lateral to the femoral vasculature, okay?

0:51

So if it were a femoral hernia, you would expect it

0:54

to be medial since that's where it would come through,

0:56

and it would have mass effect upon the femoral vein.

0:59

This indeed is tracking actually along

1:03

the iliopsoas tendon.

1:05

This is iliopsoas tendon bursitis.

1:08

We find this as an incidental

1:10

finding on a lot of CT scans.

1:12

Oftentimes, it makes clinicians very

1:14

confused or radiologists very confused.

1:16

Is this a lymph node?

1:17

Is this a hernia?

1:18

It's just fluid tracking in that iliopsoas tendon

1:21

that is going to insert on your lesser trochanter.

1:24

So just know that iliotendinitis

1:26

will have some fluid in it.

1:28

Sometimes you'll even have expansion of the iliopsoas

1:30

tendon slash muscle in cases of injuries, but it

1:33

can be something that may look like a hernia or

1:36

may look like a lymph node, and you want to know

1:38

of this diagnosis so you don't make that error.

1:41

Now this is just an inguinal

1:42

hernia containing the kidney.

1:44

I'm not sure why I put this in here, but I thought it

1:46

was somewhat interesting that that's even possible.

1:48

I like to say that's a Ripley,

1:49

believe it or not, don't know how it is.

1:51

Found another case report.

1:53

So it's happened to at least two people anyway,

1:55

so the groin hernias are always interesting.

1:57

They're always a great diagnosis.

1:59

You can hit this out of the park.

2:00

You can give the surgeons as much information so that

2:03

they can treat our patients as quickly as possible.