 Introduction/Background Abdominal wall hernias are common clinical entities presenting to a wide variety of clinical practices, from primary care to the emergency department. Presenting symptoms vary, including vague discomfort, intractable pain, or a palpable mass, which may be persistent or intermittent, symptoms of bowel obstruction, abdominal wall erythema, or it may be occult. Up to 15.2% of hernias are identified incidentally at imaging [1]. Hernias may be congenital, iatrogenic, traumatic, or related to any of the multiple causes of elevated intraabdominal pressure. The initial imaging in four hernia categories are covered in this document: 1) suspected abdominal wall hernia, such as umbilical, ventral, incisional, lumbar, spigelian; 2) suspected groin hernia, such as inguinal or femoral; 3) suspected deep pelvic hernia such as obturator, sciatic, perineal hernias; and 4) suspected diaphragmatic hernia such as traumatic, Bochdalek, or Morgagni. Imaging diagnosis of hiatal hernias is not included in this document. OR Reprint requests to: publications@acr.org Hernia Discussion of Procedures by Variant Variant 1: Suspected abdominal wall hernia such as umbilical, ventral, incisional, lumbar, or spigelian. Initial imaging. Surgical procedures create measurable alterations in the abdominal wall, which may be identified and quantified with cross-sectional imaging [5]. Shifts in relative position and atrophy of musculature are identified and may contribute to the development of incisional hernias. Abdominal wall hernias may be challenging to diagnose clinically and are prone to complications if not addressed in a timely fashion [6]. Diagnosis and presurgical planning may be achieved through several imaging modalities. Spigelian hernia is a rare form of hernia, occurring through a defect adjacent to the linea semilunaris with a reported incidence of 0.12% of all abdominal hernias [7].
Hernia.  Introduction/Background Abdominal wall hernias are common clinical entities presenting to a wide variety of clinical practices, from primary care to the emergency department. Presenting symptoms vary, including vague discomfort, intractable pain, or a palpable mass, which may be persistent or intermittent, symptoms of bowel obstruction, abdominal wall erythema, or it may be occult. Up to 15.2% of hernias are identified incidentally at imaging [1]. Hernias may be congenital, iatrogenic, traumatic, or related to any of the multiple causes of elevated intraabdominal pressure. The initial imaging in four hernia categories are covered in this document: 1) suspected abdominal wall hernia, such as umbilical, ventral, incisional, lumbar, spigelian; 2) suspected groin hernia, such as inguinal or femoral; 3) suspected deep pelvic hernia such as obturator, sciatic, perineal hernias; and 4) suspected diaphragmatic hernia such as traumatic, Bochdalek, or Morgagni. Imaging diagnosis of hiatal hernias is not included in this document. OR Reprint requests to: publications@acr.org Hernia Discussion of Procedures by Variant Variant 1: Suspected abdominal wall hernia such as umbilical, ventral, incisional, lumbar, or spigelian. Initial imaging. Surgical procedures create measurable alterations in the abdominal wall, which may be identified and quantified with cross-sectional imaging [5]. Shifts in relative position and atrophy of musculature are identified and may contribute to the development of incisional hernias. Abdominal wall hernias may be challenging to diagnose clinically and are prone to complications if not addressed in a timely fashion [6]. Diagnosis and presurgical planning may be achieved through several imaging modalities. Spigelian hernia is a rare form of hernia, occurring through a defect adjacent to the linea semilunaris with a reported incidence of 0.12% of all abdominal hernias [7].