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Objectives: To provide an updated systematic review on the performance of ultrasonography (US) in diagnosing clinically occult groin hernia., Methods: A systematic search was performed in MEDLINE and Embase. Methodological quality of included studies was assessed. Accuracy data of US in detecting clinically occult groin hernia were extracted. Positive predictive value (PPV) was pooled with a random effects model. For studies investigating the performance of US in hernia type classification (inguinal vs femoral), correctly classified proportion was assessed., Results: Sixteen studies were included. In the two studies without verification bias, sensitivities were 29.4% [95% confidence interval (CI), 15.1-47.5%] and 90.9% (95% CI, 70.8-98.9%); specificities were 90.0% (95% CI, 80.5-95.9%) and 90.6% (95% CI, 83.0-95.6%). Verification bias or a variation of it (i.e. study limited to only subjects with definitive proof of disease status) was present in all other studies. Sensitivity, specificity, and negative predictive value (NPV) were not pooled. PPV ranged from 58.8 to 100%. Pooled PPV, based on data from ten studies with low risk of bias and no applicability concerns with respect to patient selection, was 85.6% (95% CI, 76.5-92.7%). Proportion of correctly classified hernias, based on data from four studies, ranged between 94.4% and 99.1%., Conclusions: Sensitivity, specificity and NPV of US in detecting clinically occult groin hernia cannot reliably be determined based on current evidence. Further studies are necessary. Accuracy may strongly depend on the examiner's skills. PPV is high. Inguinal and femoral hernias can reliably be differentiated by US., Key Points: • Sensitivity, specificity and NPV of ultrasound in detecting clinically occult groin hernia cannot reliably be determined based on current evidence. • Accuracy may strongly depend on the examiner's skills. • PPV of US in detection of clinically occult groin hernia is high [pooled PPV of 85.6% (95% confidence interval, 76.5-92.7%)]. • US has very high performance in correctly differentiating between clinically occult inguinal and femoral hernia (correctness of 94.4- 99.1%).

Objectives: To describe a multi-dimensional MRI assessment approach with a focus on acute musculotendinous groin lesions, and to evaluate scoring reproducibility., Methods: Male athletes who participated in competitive sports and presented within 7 days of an acute onset of sports-related groin pain were included. All athletes underwent MRI (1.5 T) according to a standardized groin-centred protocol. From several calibration sessions, a system was developed assessing grade, location and extent of muscle strains, peri-lesional haematoma, as well as other non-acute findings commonly associated with long-standing groin pain. Kappa (K) statistics and intraclass correlation coefficients (ICCs) were used to describe intra- and inter-rater reproducibility., Results: Seventy-five athletes (mean age 26.6 ± 4.4 years) were included in the analyses, and 85 different acute lesions were observed. Adductor longus lesions were most common (42.7 %) followed by rectus femoris lesions (16.3 %). Kappa values ranged between 0.70 and 1.00 for almost all categorical features for acute lesions, with almost perfect intra- and inter-rater agreement (K = 0.89-1.00) for presence, number, location and grading of lesions. ICCs ranged between 0.77 and 1.00 for continuous measures of acute lesion extent., Conclusions: A standardized MRI assessment approach of acute groin injuries was described and showed good intra- and inter-rater reproducibility., Key Points: • A multidimensional MRI assessment approach for acute groin injuries was described. • Standardized MRI assessment of acute musculotendinous groin injuries has high reproducibility. • Injury location and injury extent can be scored reliably using 1.5 T MRI.

This prospective study examined the accuracy of ultrasound in diagnosing occult groin hernias in adults. The study included 52 consecutive patients reviewed in the surgical out-patient clinic with a history suggestive of groin hernia but with a normal or inconclusive clinical examination. Each patient underwent a preliminary ultrasound examination by an experienced consultant radiologist who was aware that the patient had a history suggestive of a hernia but was blinded to the side of the symptoms. The patient then proceeded to herniography, and some patients also had surgical exploration. The results of the ultrasound were assessed in relation to the herniography, and the patients who proceeded to surgical exploration had further correlation with surgery. Ultrasound had a sensitivity of 29% and specificity of 90% compared with the herniography. Correlation with surgical findings showed ultrasound to have a sensitivity of 33% and a specificity of 100%. The sensitivity of ultrasound in detecting clinically occult hernias in a non-acute presentation is poor, and patients with normal ultrasound should be considered for further investigation.

Psoas abscess is an uncommon condition and, contrary to traditional teaching, tends to be of non-tuberculous aetiology in developed countries. Diagnosis can be delayed since presenting features are non-specific and in many instances misleading, necessitating a high degree of clinical suspicion and early resort to cross-sectional imaging using CT or MRI. We present a case of iliopsoas abscess secondary to perforated diverticulitis to illustrate the difficulty encountered in early diagnosis and to show that successful management of secondary psoas abscess necessitates surgical resection of the underlying condition in most cases.

The inguinofemoral region is a crossroads of numerous vascular, nervous and muscular structures. As even the most astute clinician can have difficulty in correctly diagnosing the cause of complaints or a mass in the groin and thigh region, radiological investigation is frequently warranted. For the radiologist involved, knowledge of the anatomy and specific pathology of the groin is essential. This paper deals with the imaging characteristics of the various diseases in the inguinofemoral triangle. Furthermore, this article provides an overview of the role of the various imaging modalities in the evaluation of disease in the groin and upper thigh. A sound working knowledge of groin anatomy and pathology is mandatory. The various imaging modalities used should be considered complementary.