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DOI: 10.1148/rg.283075110
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The Inguinal Canal: Anatomy and Imaging Features of Common and Uncommon Masses1

Priya R. Bhosale, MD, Madhavi Patnana, MD, Chitra Viswanathan, MD, and Janio Szklaruk, MD, PhD

1 From the Department of Radiology, University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Blvd, Box 368, Houston, TX 77030. Presented as an education exhibit at the 2006 RSNA Annual Meeting. Received May 10, 2007; revision requested July 3; final revision received September 28; accepted October 9. All authors have no financial relationships to disclose.

Figure 1
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  		Figure 1.  Coronal diagram of the male inguinal anatomy. The inguinal ligament (red arrow) is the aponeurosis of the external oblique muscle. A = aponeuroses of the transversus abdominis muscle, EO = external oblique, IO = internal oblique, TA = transversus abdominis.

 

Figure 2
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  		Figure 2.  Coronal diagram of the male inguinal anatomy. The deep inguinal ring (black arrow) is the site of an outpouching of the transversalis fascia and lies lateral to the inferior epigastric vessels. (Red arrow = inferior epigastric vein.) The transversalis fascia (white arrow) continues into the canal, forming the innermost covering of the structures traversing the IC. EA = external iliac artery, EV = external iliac vein, P = peritoneum, VD = vas deferens.

 

Figure 3
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  		Figure 3.  Coronal diagram of the male inguinal anatomy. The superficial inguinal ring (blue arrow) is formed by the split in the aponeurosis. The medial and lateral margins of this ring are called the crura; the medial crus is attached to the pubic crest, and the lateral crus is attached to the pubic tubercle. White arrow = bladder.

 

Figure 4
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  		Figure 4.  Coronal diagram of the male IC anatomy shows the vas deferens (white arrow), the testicular artery (red arrow), the superficial inguinal ring (green arrow), the pampiniform plexus (black arrow), and the genital branch of the genitofemoral nerve (blue arrow).

 

Figure 5
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  		Figure 5.  Herniated bladder in a 70-year-old man with lymphoproliferative disorder. Axial contrast-enhanced CT image shows a herniated bladder in the right IC (arrow).

 

Figure 6
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  		Figure 6.  Herniated appendix in a 73-year-old man with squamous cell carcinoma of the anus. Axial contrast-enhanced CT image shows a normal appendix in the right IC (arrow).

 

Figure 7
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  		Figure 7.  Herniated small bowel loops in a 66-year-old man with adenocarcinoma of the rectum. Sagittal reformatted image from contrast-enhanced CT shows small bowel loops in the left IC (arrows).

 

Figure 8A
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  		Figure 8a.  Herniated large bowel in a 55- year-old man with hepatocellular carcinoma. (a) Axial contrast-enhanced CT image shows herniated large bowel and appendix in the right IC (arrows). (b) Coronal diagram shows an IC hernia that contains colon (arrow).

 

Figure 8B
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  		Figure 8b.  Herniated large bowel in a 55- year-old man with hepatocellular carcinoma. (a) Axial contrast-enhanced CT image shows herniated large bowel and appendix in the right IC (arrows). (b) Coronal diagram shows an IC hernia that contains colon (arrow).

 

Figure 9A
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  		Figure 9a.  Herniated ovaries in a 55-year-old woman with lymphoma. (a) Axial contrast-enhanced CT image shows bilateral IC hernias containing ovaries (arrows). (b) Coronal diagram shows an IC hernia containing an ovary (black arrow). White arrow = fallopian tube, red arrow = ovarian ligament.

 

Figure 9B
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  		Figure 9b.  Herniated ovaries in a 55-year-old woman with lymphoma. (a) Axial contrast-enhanced CT image shows bilateral IC hernias containing ovaries (arrows). (b) Coronal diagram shows an IC hernia containing an ovary (black arrow). White arrow = fallopian tube, red arrow = ovarian ligament.

 

Figure 10A
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  		Figure 10a.  Cryptorchidism in a 65-year-old man with colon cancer. (a) Coronal T1-weighted MR image shows a low-signal-intensity mass in the IC (arrow), which represents a testicle. (b) On an axial T2-weighted MR image, the testicle has high signal intensity (arrow).

 

Figure 10B
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  		Figure 10b.  Cryptorchidism in a 65-year-old man with colon cancer. (a) Coronal T1-weighted MR image shows a low-signal-intensity mass in the IC (arrow), which represents a testicle. (b) On an axial T2-weighted MR image, the testicle has high signal intensity (arrow).

 

Figure 11
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  		Figure 11.  Spermatic cord lipoma in a 64-year-old man with a history of prostate carcinoma. Axial T2-weighted MR image shows a mass of fat signal intensity (arrow) lateral to the left spermatic cord. The mass represents a lipoma.

 

Figure 12
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  		Figure 12.  Hematoma in a 35-year-old man with a mass in the IC after surgical resection of a lipoma. Axial CT image shows a mass with high attenuation (58 HU) in the right IC (arrow). The mass represents a hematoma.

 

Figure 13
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  		Figure 13.  Abscess in a 66-year-old man with rectal adenocarcinoma. Sagittal T2-weighted MR image shows a mass of heterogeneous intermediate signal intensity (arrow) extending into the left IC. The mass represents an abscess.

 

Figure 14A
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  		Figure 14a.  Neurofibromas in a 46-year-old man with a history of neurofibromatosis. (a) Axial CT image shows low-attenuation masses in the left hemipelvis that extend into the inguinal region with involvement of the ilioinguinal nerve (arrow). The masses represent plexiform neurofibromas. (b) Coronal diagram shows a neurofibroma (arrow) arising from the ilioinguinal nerve.

 

Figure 14B
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  		Figure 14b.  Neurofibromas in a 46-year-old man with a history of neurofibromatosis. (a) Axial CT image shows low-attenuation masses in the left hemipelvis that extend into the inguinal region with involvement of the ilioinguinal nerve (arrow). The masses represent plexiform neurofibromas. (b) Coronal diagram shows a neurofibroma (arrow) arising from the ilioinguinal nerve.

 

Figure 15
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  		Figure 15.  Varicocele in a 35-year-old man with a right-sided extraadrenal paraganglioma that caused obstruction of the right gonadal vein. CT image shows an enhancing serpentine mass in the right IC (arrow). The mass is due to engorgement of the pampiniform plexus and represents a right varicocele.

 

Figure 16A
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  		Figure 16a.  Desmoid tumor in a 33-year-old man. (a) Axial T1-weighted MR image shows a low-signal-intensity mass (arrow) in the right IC. (b) Axial fat-saturated gadolinium-enhanced T1-weighted MR image shows homogeneous enhancement of the mass (arrow). (c) Axial T2-weighted MR image shows the low-signal-intensity mass (arrow).

 

Figure 16B
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  		Figure 16b.  Desmoid tumor in a 33-year-old man. (a) Axial T1-weighted MR image shows a low-signal-intensity mass (arrow) in the right IC. (b) Axial fat-saturated gadolinium-enhanced T1-weighted MR image shows homogeneous enhancement of the mass (arrow). (c) Axial T2-weighted MR image shows the low-signal-intensity mass (arrow).

 

Figure 16C
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  		Figure 16c.  Desmoid tumor in a 33-year-old man. (a) Axial T1-weighted MR image shows a low-signal-intensity mass (arrow) in the right IC. (b) Axial fat-saturated gadolinium-enhanced T1-weighted MR image shows homogeneous enhancement of the mass (arrow). (c) Axial T2-weighted MR image shows the low-signal-intensity mass (arrow).

 

Figure 17
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  		Figure 17.  Air in the IC in a 57-year-old man with colon cancer and perforation of the bowel. Axial CT image shows air in the left IC (arrow).

 

Figure 18
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  		Figure 18.  Contrast material in the IC in a 56-year-old man with a perforated gastric ulcer. Axial CT image shows extravasated oral contrast material in the left IC (arrow).

 

Figure 19A
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  		Figure 19a.  Hydrocele in a 12-year-old patient with rhabdomyosarcoma. (a) Axial CT image shows a mass with fluid attenuation (20 HU) in the right IC (arrow), a finding consistent with a hydrocele. (b) Sagittal diagram shows an encysted hydrocele (arrow), which does not communicate with the peritoneum or tunica vaginalis.

 

Figure 19B
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  		Figure 19b.  Hydrocele in a 12-year-old patient with rhabdomyosarcoma. (a) Axial CT image shows a mass with fluid attenuation (20 HU) in the right IC (arrow), a finding consistent with a hydrocele. (b) Sagittal diagram shows an encysted hydrocele (arrow), which does not communicate with the peritoneum or tunica vaginalis.

 

Figure 20
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  		Figure 20.  Sagittal diagram shows a funicular hydrocele (arrow), which communicates with the peritoneum at the internal ring.

 

Figure 21
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  		Figure 21.  Penile urethral prosthesis in a 72-year-old man with a history of prostate cancer who had urinary incontinence after a prostatectomy. Volume-rendered image from axial CT shows a penile urethral prosthesis with the reservoir (projecting over the right iliac wing) and tubing that traverses the IC. There are two tubes: The tube that traverses the IC (white arrow) connects the reservoir to the scrotal pump; a second tube (black arrows) connects the scrotal pump to the urethral cuff. (The appearance of three tubes is due to tubing being coiled in the IC and inguinal region.) To allow urination, the patient squeezes the pump, which causes a flow of saline solution out of the cuff and into the reservoir.

 

Figure 22
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  		Figure 22.  Liposarcoma in a 56-year-old man with a history of liposarcoma. Axial CT image of the pelvis obtained with intravenous contrast material shows a fat attenuation mass (white arrow), which contains thin septa of soft-tissue attenuation and a calcification (black arrow).

 

Figure 23
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  		Figure 23.  Burkitt lymphoma in a 17-year-old boy. Axial contrast-enhanced CT image shows enlarged and enhancing spermatic cords bilaterally (arrows), which represent lymphomatous involvement.

 

Figure 24
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  		Figure 24.  Embryonal carcinoma in a 28-year-old man. Coronal T2-weighted MR image shows a mass of heterogeneous signal intensity that arises from the left testicle (white arrow), involves the spermatic cord, and extends into the superficial inguinal ring (black arrow).

 

Figure 25
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  		Figure 25.  Unclassified sarcoma in a 54-year-old man. Coronal reformatted CT image shows a tumor of soft-tissue attenuation (arrow) infiltrating into the left spermatic cord.

 

Figure 26
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  		Figure 26.  Metastases in a 12-year-old boy with alveolar rhabdomyosarcoma. Axial CT image obtained with intravenous contrast material shows an enhancing mass in the right IC and a soft-tissue mass in the left IC (arrows).

 

Figure 27A
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  		Figure 27a.  Metastasis in a 35-year-old woman with monophasic sarcoma. (a) Axial T1-weighted MR image shows a low-signal-intensity mass in the right IC (arrow). (b) Axial T2-weighted MR image shows that the mass has high signal intensity (arrow). (c) Axial gadolinium-enhanced T1-weighted MR image shows enhancement of the mass (arrow).

 

Figure 27B
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  		Figure 27b.  Metastasis in a 35-year-old woman with monophasic sarcoma. (a) Axial T1-weighted MR image shows a low-signal-intensity mass in the right IC (arrow). (b) Axial T2-weighted MR image shows that the mass has high signal intensity (arrow). (c) Axial gadolinium-enhanced T1-weighted MR image shows enhancement of the mass (arrow).

 

Figure 27C
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  		Figure 27c.  Metastasis in a 35-year-old woman with monophasic sarcoma. (a) Axial T1-weighted MR image shows a low-signal-intensity mass in the right IC (arrow). (b) Axial T2-weighted MR image shows that the mass has high signal intensity (arrow). (c) Axial gadolinium-enhanced T1-weighted MR image shows enhancement of the mass (arrow).

 

Figure 28
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  		Figure 28.  Pseudomyxoma peritonei in a 61-year-old man with appendiceal adenocarcinoma. Axial CT image obtained with intravenous contrast material shows a low-attenuation mucinous deposit in the right IC (arrow). The mucinous deposit represents pseudomyxoma peritonei.

 

Figure 29A
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  		Figure 29a.  Metastasis in a 6-year-old boy with Wilms tumor. (a) Axial CT image obtained with intravenous contrast material shows a heterogeneously enhancing mass (arrow) arising from the right kidney. (b) Axial contrast-enhanced CT image shows a mass in the right IC (arrow). The mass is isoattenuating relative to muscle and represents a metastasis from the Wilms tumor.

 

Figure 29B
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  		Figure 29b.  Metastasis in a 6-year-old boy with Wilms tumor. (a) Axial CT image obtained with intravenous contrast material shows a heterogeneously enhancing mass (arrow) arising from the right kidney. (b) Axial contrast-enhanced CT image shows a mass in the right IC (arrow). The mass is isoattenuating relative to muscle and represents a metastasis from the Wilms tumor.

 




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