A Case Study: Diagnosis of Grynfeltt-Lesshaft Hernia Via Dynamic Ultrasound Imaging Techniques

Purpose

The purpose of this case study is to inform sonographers on the diagnosis, ultrasound appearance, and implementation of dynamic ultrasound scanning techniques of Grynfeltt-Lesshaft hernias.

Materials and Methods

Using both static and dynamic ultrasound imaging techniques to evaluate acute presentation of an atraumatic lumbar mass with fluctuation in size in a female patient over 60 years of age, the diagnosis of Grynfeltt-Lesshaft hernia was established. When evaluating lumbar masses, the role of the sonographer must include dynamic stress maneuvers via Valsalva maneuver and manual external probe pressure in order to determine mobility of masses and assess integrity of adjacent anatomical structures. Investigation of deep anatomical structures in addition to views of a seemingly superficial mass is crucial for accurate diagnosis via ultrasound.

Results

Per the recommendation of the interpreting radiologist, additional CT imaging was obtained and the ultrasound findings were confirmed. After the diagnosis of Grynfeltt-Lesshaft lumbar hernia was established, the recommended course of treatment was surgical repair of the structural defect of the lumbar triangle.

Conclusions

Grynfeltt-Lesshaft lumbar hernia is a very rare kind of lumbar hernia with fewer than three hundred documented cases. The role of the sonographer in evaluating lumbar masses must include investigation of anatomical structures deep to the superficial lumbar mass in question in conjunction with dynamic imaging techniques. An in-depth examination of the superficial and deep anatomy throughout the ultrasound enables physicians to establish a critical diagnosis and expedite treatment for the patient to avoid potential complications such as bowel incarceration.