Understanding the fascinating world of muscular anatomical variants is essential for MSK sonographers who are undeniably students of anatomy. This presentation includes numerous case studies and dynamic ultrasound clips to review accessory muscles, supernumerary slips and developmental differences so that we can turn 'abnormal' into anatomical insight and incorporate variant recognition into routine scanning protocols.

Introduction: Patient is a 43 year old female with a protruding lump on the right labial region. The patient has had the lump for several months and it was previously diagnosed as a lipoma, however remarks that the lump increases in size upon any pelvic floor straining exercises such as squats or lower body Pilates.
Method: A linear probe L6-15 was used on the GE Logiq Fortis, it was explained that the scanning will be done externally but the patient would have to remove their underwear or move it to the side to access the region of interest. The patient signed the consent form and changed into a gown. The scan was completed taking a series of images in longitudinal and transverse planes as well as cine-loops to highlight compression and movement of contents through the hernia defect.
Results: Findings were that there was a defect in the right labia majora fascia resulting in a hernia, with the defect measuring 9.1mm x 8.6mm, the contents were subcutaneous tissue.
Conclusion: In conclusion, hernias in this region are often rare but without ultrasound investigation and the dynamic nature of ultrasound it can often be misdiagnosed.
Take home message: Listening to patients symptoms and how/when they occur can inform us greatly about what is happening, additionally using dynamic measures in ultrasound such as compressing lesions is critical to fully assess the condition resulting in a correct diagnosis.