Inguinal/Femoral Swelling

Differential Overview

Inguinal Swelling

❑ Direct inguinal hernia

❑ Indirect inguinal hernia

❑ Hydrocele

❑ Infectious inguinal lymphadenopathy

❑ Malignant lymphadenopathy

Femoral Swelling

❑ Infectious femoral lymphadenopathy

❑ Femoral hernia

❑ Ectopic testis

❑ Bursal swelling

❑ Lipoma

❑ Obturator hernia

❑ Spigelian hernia

❑ Saphenous varix

❑ Femoral aneurysm

❑ Psoas abscess

Diagnostic Approach

Using the landmarks of the anterior superior iliac spine and the pubic spine that define the inguinal (Poupart) ligament, separate the femoral region below from the inguinal region above. Examine the patient both lying and standing.

If you are able to get your fingers above a lump, it is not a hernia. Femoral swelling that is reducible and gives an impulse on coughing includes femoral hernia, saphenous varix, and psoas abscess. Signs of intestinal obstruction associated with an irreducible hernia indicate ischemia.

Clinical Findings

Direct inguinal hernia  The swelling comes directly forward on standing and retreats backward with pressure. It is globular and posterior to the spermatic cord.

Indirect inguinal hernia  It appears obliquely across the lower abdomen. The sac is tubular and anterior to the spermatic cord, and when in the scrotum, it is anterior to the testicle.

Hydrocele  A transilluminating swelling surrounds the testicle and extends to the inguinal canal. Downward traction on the testis will pull a hydrocele (but not a hernia) with it. In women, a hydrocele of the canal of Nuck produces a smooth, fixed, translucent swelling.

Infectious inguinal lymphadenopathy  Tender nodules appear subcutaneously around the inguinal ligament, draining the external genitalia, rectum, lower abdomen and back, and upper third of the thigh. Classic examples include tender, red nodes with scabies and a hard, painless node with a chancre of syphilis.

Malignant lymphadenopathy  The nodes are characterized by bulkiness and firmness, progressive growth, and early fixation without inflammation. Adenopathy in other locations, splenomegaly, weight loss, or night sweats are helpful confirmatory signs.

Infectious femoral lymphadenopathy  A tender swollen lump develops with a source of cutaneous infection in the lower two-thirds of the leg.

Femoral hernia  Occurring more commonly in women, it is recognized by its femoral position. If reduced, it will tap the fingers when the patient coughs.

Ectopic testis  There is an empty scrotum, with a lump in the inguinal canal.

Bursal swelling  Located between the iliopsoas tendon and hip joint, it is tender.

Lipoma  Soft in consistency with a lobulated edge, it lies completely outside the fascia.

Obturator hernia  Swelling is below the pubic ramus, compared with a femoral hernia, which is above. The hip is held in flexion.

Spigelian hernia  The lump is a few centimeters above the inguinal ligament.

Saphenous varix  Associated with large varicosities of the legs, a thrill is palpable. It fills gradually, rather than with a pop as a femoral hernia does.

Femoral aneurysm  It presents as an expansile pulsation with a bruit.

Psoas abscess  Tender fluctuance is present both below and above Poupart ligament. Back spasm with curvature toward the side of the lesion is a common compensatory reaction.

Book Source Details

• Book Title: Field Guide to Bedside Diagnosis
• Author(s): David S. Smith
• Year of Publication: 2007
• Copyright Details: Field Guide to Bedside Diagnosis, Copyright © 2007 Lippincott Williams & Wilkins.

Other Book Chapters Related to Groin swelling

Read excerpts from these other book chapters related to Groin swelling:

Copyright Details: Field Guide to Bedside Diagnosis, Copyright © 2008 Williams & Wilkins.

More About Causes of Groin swelling

• Back to symptom: Groin swelling: Introduction (review 34 causes)
• Next Book Extract About Groin swelling: Pulmonary edema (Handbook of Diseases)
• All Book Extracts: All Online Book Extracts for Groin swelling

More About This Book: Title: Field Guide to Bedside Diagnosis Authors: David S. Smith Publisher: Lippincott Williams & Wilkins Copyright: 2007 ISBN: 0-78178-165-5

 » Next page: Pulmonary edema (Handbook of Diseases)

Rate This Website

What do you think about the features of this website? Take our user survey and have your say:

Website User Survey

Medical Tools & Articles:

Next articles:

• Pulmonary edema (Handbook of Diseases)
• Edema, facial (Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series)
• Edema, generalized (Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series)
• Edema of the arm (Signs & Symptoms: A 2-in-1 Reference for Nurses)
• Edema of the face (Signs & Symptoms: A 2-in-1 Reference for Nurses)

Tools & Services:

• Bookmark this page
• Take a survey relating to Groin swelling
• Symptom Search
• Symptom Checker
• Medical Dictionary
• Give your feedback

Medical Articles:

• Disease & Treatments Search
• Misdiagnosis Center
• Full list of interesting articles

Forums & Message Boards

• Ask or answer a question at the Boards:
• I cannot get a diagnosis. Please help.
• Tell us your medical story.
• Share your misdiagnosis story.
• What is the best treatment for my condition?
• See all the Boards.

Enter your search terms Submit search form
Search The Web Search wrongdiagnosis.com

Common Health Mistakes

Symptom
Checker

Search Specialists by State and City