GROIN MASS

A mass of the groin found on routine examination is most likely an enlarged lymph node. On the other hand, 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.

GROIN MASS

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.

1. 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.
2. 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 (see page 360). 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 (rheumatoid, gouty, or osteoarthritis) of the joint. Finally, osteomyelitis of the hip bones must be considered.
3. N—Neoplasms suggest skin tumor (see page 469), lipoma, tumor of the lymph node such as Hodgkin disease and metastatic tumor, and sarcoma of the bone.
4. T—Trauma would include 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 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

1. CBC (abscess)
2. Tuberculin test (psoas abscess)
3. Protein electrophoresis (multiple myeloma)
4. X-rays of the hips (metastatic tumor, multiple myeloma)
5. VDRL test (chancre with regional lymphadenitis)
6. Small-bowel series (hernia)
7. Lymphangiogram (neoplasm of the lymph glands)
8. Sonogram (saphenous varix, aneurysm)

Book Source Details

• Book Title: Differential Diagnosis in Primary Care
• Author(s): R. Douglas Collins
• Year of Publication: 2007
• Copyright Details: Differential Diagnosis in Primary Care, Copyright © 2007 Lippincott Williams & Wilkins.

Other Book Chapters Related to Groin symptoms

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Copyright Details: Differential Diagnosis in Primary Care, Copyright © 2008 Williams & Wilkins.

More About Causes of Groin symptoms

• Back to symptom: Groin symptoms: Introduction (review 43 causes)
• Next Book Extract About Groin symptoms: GROIN PAIN (Differential Diagnosis in Primary Care)
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More About This Book: Title: Differential Diagnosis in Primary Care Authors: R. Douglas Collins Publisher: Lippincott Williams & Wilkins Copyright: 2007 ISBN: 0-7817-6812-8

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