October 05, 2010

Q&A: Diagnosis of Groin Lumps

Lumps in the groin and scrotum can occur at any age. Clinical assessment is needed to detect those which need urgent investigation or treatment. Usually a working diagnosis can be made clinically, and ultrasound is often helpful.

This article is for Medical Students & Professionals
This is a Question & Answer revision article designed for medical students and professionals preparing for the PLAB, MRCP or USMLE examinations. They are based on actual questions from these examinations. You may find more useful one of our many articles on Diseases & Conditions, Medical Syndromes, Health & Wellness or Home Remedies.
In this article:
Causes of groin lumps
MCQ exam: clinical scenario
MCQ exam: answer
MCQ exam: explanation

Causes of groin lumps

Groin lumps may be painful or painless. A useful classification when assessing aetiology classifies them into 2:

1). Painful lumps:
  • Tender lymph nodes.
  • Strangulated femoral or inguinal hernia.
  • Psoas abscess.
2). Painless lumps:
  • Skin swellings - eg, epidermal (sebaceous) cyst, contact dermatitis.
  • Non-tender nodes.
  • Femoral or inguinal hernia.
  • Undescended, maldescended or ectopic testis.
  • Vascular:
    • Femoral artery aneurysm.
    • Saphena varix (varicosity of saphenous vein at the junction with the femoral vein).

MCQ exam: clinical scenario

A 25 year old body builder presents to his physician with a swelling in the groin. He has never been to see a doctor before. On examination, the patient is afebrile, the mass is 3cm x 3cm. It can be reduced on gentle palpation. When asked to cough, an impulse is felt by the physician and a mass appears inferomedial to the external ring in the inguinal region.

The most likely diagnosis is:

a) Enlarged lymph node
b) Ectopic testes
c) Indirect inguinal hernia
d) Saphena varix
e) Direct inguinal hernia

MCQ questions & answers on medicalnotes.info

MCQ exam: answer

The correct answer is E.

MCQ exam: explanation

Heavy lifting is more likely to result in a DIRECT hernia. Direct inguinal hernias are secondary to a developed weakness of the transversalis fascia in the floor of Hesselbach's triangle. The sac is usually composed of a single layer, the peritoneum. It passes through or around the Conjoint tendon to reach the Superficial inguinal ring; thus it does not pass through the deep inguinal ring.

Some have suggested that these hernias are related to heriditary or acquired defects in collagen synthesis or turnover. Hernia and Saphena varix can give a cough impulse, however the incidence of hernia is higher.

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