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The challenging sonographic inguinal canal evaluation in neonates and children: an update of differential diagnoses

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Abstract

Bulging of the inguinal region is a frequent complaint in the pediatric population and sonographic findings can be challenging for radiologists. In this review we update the sonographic findings of the most common disorders that affect the inguinal canal in neonates and children, with a focus on the processus vaginalis abnormalities such as congenital hydroceles, indirect inguinal hernias and cryptorchidism, illustrated with cases collected at a quaternary hospital during a 7-year period. We emphasize the importance of correctly classifying different types of congenital hydrocele and inguinal hernia to allow for early surgical intervention when necessary. We have systematically organized and illustrated all types of congenital hydrocele and inguinal hernias based on embryological, anatomical and pathophysiological findings to assist readers in the diagnosis of even complex cases of inguinal canal ultrasound evaluation in neonates and children. We also present rare diagnoses such as the abdominoscrotal hydrocele and the herniation of uterus and ovaries into the canal of Nuck.

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Acknowledgments

The authors wish to thank Dr. Walther Y. Ishikawa for the medical illustrations in Fig. 1 and Ana C. Miti Sameshima for those in Figs. 4 and 5. The images in Figs. 11 and 18 are courtesy of Dr. Aureliano T. Brandão and Dr. Gerson Weinmann, respectively. The authors are also grateful to the anonymous reviewers for their valuable comments and suggestions.

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Authors and Affiliations

  1. Diagnostic Imaging Department, Hospital Israelita Albert Einstein, Av. Albert Einstein, 627/701, 05651-901, São Paulo, SP, Brazil

    Yoshino T. Sameshima, Maurício G. I. Yamanari, Mariana A. Silva, Miguel J. Francisco Neto & Marcelo B. G. Funari

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  1. Yoshino T. Sameshima
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  2. Maurício G. I. Yamanari
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Correspondence to Yoshino T. Sameshima.

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Sameshima, Y.T., Yamanari, M.G.I., Silva, M.A. et al. The challenging sonographic inguinal canal evaluation in neonates and children: an update of differential diagnoses. Pediatr Radiol 47, 461–472 (2017). https://doi.org/10.1007/s00247-016-3706-8

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