To the Editor.
—In his Clinical Crossroads discussion of inguinal hernias, Dr Wantz1 alluded to several imaging modalities that may demonstrate a hernia, eg, sonography, computed tomography (CT), and magnetic resonance imaging (MRI). These techniques are insensitive for the detection of inguinal hernias unless the hernia is incarcerated. Both CT and MRI are usually performed with the patient supine, and in that position inguinal hernias tend to reduce. If the scan is performed with the patient in the prone position, the hernia may appear to be reduced because of extrinsic pressure from the table. Ultrasonic examinations may be performed with the patient standing, thereby simulating the conditions under which the physical examination is conducted.Wantz did not refer to the more useful and specific imaging examination, herniography.2 Using opaque contrast material injected intraperitoneally, herniography is a sensitive method to demonstrate hernias. Herniography is unnecessary when the clinical diagnosis
Hamlin JA. Clinical Crossroads: A 65-Year-Old Man With an Inguinal Hernia. JAMA. 1997;277(21):1678-1679. doi:10.1001/jama.1997.03540450034021