GROIN MASS
A mass of the groin found on routine examination is most likely an
enlarged lymph node. In contrast, when the patient presents with a groin
mass for diagnosis, it is probably a hernia. But why diagnose by
probability? A systematic approach will avoid misdiagnoses and should make
medicine more fun.
Visualize the anatomy of the groin. There are skin, subcutaneous tissue, and
the inguinal and femoral canals; underneath these are the saphenous and
femoral veins, the femoral artery and nerve, and lymph nodes. In the next
layer are the psoas and iliac muscles and the bones and ligaments of the hip
joints. Apply the mnemonic MINT to these structures, and the following
list of possibilities may be arrived at.
M—Malformations suggest inguinal and femoral hernias in the fascia,
hydroceles, and undescended testicles in the inguinal canal. A saphenous
varicocele and iliac aneurysm are also malformations to consider.
I—Inflammatory lesions include cellulitis, acute adenitis (usually
secondary to venereal disease or skin disease) and chronic adenitis
secondary to tuberculosis or a systemic disease . In addition, tuberculosis may cause a psoas abscess,
there may be thrombophlebitis of the saphenous or femoral vein (especially
postpartum), or there may be arthritis (RA, gout, or osteoarthritis) of the joint. Finally, osteomyelitis of the hip
bones must be considered.
N—Neoplasms suggest skin tumor , lipoma, tumor of the lymph node such as Hodgkin lymphoma and
metastatic tumor, and sarcoma of the bone.
T—Trauma includes a perforation of the femoral vein or artery,
contusion and fracture, or dislocation of the hip.
Approach to the Diagnosis
Obviously, the approach to diagnosis involves differentiating enlarged
lymph nodes from other conditions. Hernias are usually reducible; if they
are not, they are extremely tender, and the patient often experiences
gastrointestinal (GI) complaints. They do not transilluminate, and bowel
sounds can often be heard over them. The location of inguinal hernias above
the inguinal ligament should help differentiate them from lymph nodes and
femoral hernias, which are below the inguinal ligament. Lymphadenitis will
usually be associated with a lesion on the genitalia (e.g., chancre) or the
lower extremity. Exploratory surgery and lymph node biopsy may be necessary
to make a definitive diagnosis. Phlebography may be necessary to rule out
venous thrombosis and angiography to rule out aneurysm.
Other Useful Tests
-
CBC (abscess)
- Tuberculin test (psoas abscess)
- Protein electrophoresis (multiple myeloma)
- X-rays of the hips (metastatic tumor, multiple myeloma)
- VDRL test (chancre with regional lymphadenitis)
- Small-bowel series (hernia)
- Lymphangiogram (neoplasm of the lymph glands)
- Sonogram (saphenous varix, aneurysm)
Pictures
Book Source Details
- Book Title: Differential Diagnosis in Primary Care
- Author(s): R. Douglas Collins MD, FACP
- Year of Publication: 2007
- Copyright Details: Differential Diagnosis in Primary Care, Copyright © 2007 Lippincott Williams & Wilkins.
Other Book Chapters Related to Groin pain
Read excerpts from these other book chapters related to Groin pain:
Medical Books Excerpts
- HIP PAIN
- "Algorithmic Diagnosis of Symptoms and Signs" (2003)
- [ read ]
- Hip Pain
- "In A Page: Pediatric Signs and Symptoms" (2007)
- [ read ]
- HIP PAIN
- "Differential Diagnosis in Primary Care" (2007)
- [ read ]
- Hip Pain
- "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
- [ read ]
- HIP PAIN
- "Differential Diagnosis in Primary Care" (2007)
- [ read ]
Copyright Details: Differential Diagnosis in Primary Care, Copyright © 2008 Williams & Wilkins.
More About Causes of Groin pain
» Next page: HIP PAIN (Differential Diagnosis in Primary Care)
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