What are the recommended imaging modalities for assessing groin hernias in primary care?

Recommended imaging modalities for assessing groin hernias in primary care focus primarily on clinical examination, with imaging reserved for uncertain cases. In UK primary care, initial assessment of suspected groin hernias is predominantly clinical, relying on history and physical examination to identify a palpable or visible bulge ¹. Imaging is not routinely recommended unless the diagnosis is unclear or complications are suspected.

When imaging is indicated, ultrasound is the preferred first-line modality. Ultrasound is non-invasive, widely available in primary care or community settings, and effective at detecting groin hernias, including differentiating hernia types and identifying contents (e.g., bowel, fat) (Expert Panel on Gastrointestinal Imaging et al., 2022). It is also useful for evaluating intermittent or occult hernias not evident on examination ¹.

Other imaging modalities such as MRI or CT are generally reserved for complex cases or when ultrasound results are inconclusive. MRI offers superior soft tissue contrast and can be used to clarify equivocal ultrasound findings or assess complicated hernias, but it is less accessible and not typically used in primary care (Expert Panel on Gastrointestinal Imaging et al., 2022). CT scanning is usually reserved for emergency or surgical planning contexts rather than initial primary care assessment ¹.

In summary, UK guidelines emphasise clinical diagnosis with ultrasound as the primary imaging tool when needed in primary care, aligning with expert imaging panel recommendations that support ultrasound as the first-line modality for groin hernia evaluation (Expert Panel on Gastrointestinal Imaging et al., 2022) ¹.