Makindo Medical Notes Comprehensive Medical Encyclopedia | Education for Healthcare Professionals

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Lump in Groin

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Clinical History

Onset and Duration: Ask the patient when the lump was first noticed and whether it has changed in size or appearance over time.
Pain: Determine if the lump is painful or tender. Painful lumps may suggest an abscess, lymphadenitis, or strangulated hernia, while painless lumps may suggest a hernia, lipoma, or aneurysm.
Changes with Activity: Inquire if the lump changes in size or prominence with activities like standing, lifting, or coughing. Hernias, for example, often become more noticeable with straining or exertion.
Systemic Symptoms: Ask about associated symptoms such as fever (suggesting infection), weight loss (suggesting malignancy), or urinary and bowel symptoms.

Physical Examination

Location: Identify the exact location of the lump (inguinal, femoral, or other) to help differentiate between inguinal and femoral hernias or other causes.
Characteristics: Palpate the lump to assess its consistency (soft, firm, pulsatile), reducibility (can it be pushed back in), and mobility.
Pulsatility: Check if the lump is pulsatile, which could suggest a femoral aneurysm.
Associated Skin Changes: Look for redness, warmth, or ulceration, which may indicate infection or malignancy.
Examine Nearby Structures: Examine the scrotum, testicles, and lower limb for signs of edema or other abnormalities.

Diagnostic Tests

Ultrasound: A first-line imaging modality to differentiate between soft tissue, hernia, lymphadenopathy, and vascular lesions.
CT Scan: Recommended for complicated or unclear cases, particularly to assess hernias, malignancies, or deep vascular structures.
Blood Tests: Full blood count (FBC), inflammatory markers (ESR/CRP), and infection-specific tests (e.g., STI screening) if infection is suspected.
Biopsy: If malignancy or lymphadenopathy is suspected, consider fine-needle aspiration or excisional biopsy.

Management

Hernias: Surgical repair is the definitive treatment, especially for incarcerated or strangulated hernias. Elective surgery is an option for reducible hernias.
Lymphadenopathy: Treat underlying infections with antibiotics or antivirals. If malignancy is suspected, refer for oncological management.
Abscess: Incision and drainage, followed by antibiotic therapy, if indicated.
Aneurysms: Refer to vascular surgery for potential surgical repair to prevent rupture.
Referral: Urgent referral for suspected malignancy, or if complications arise (e.g., ischaemia, obstruction).

Patient Education

Advise the patient on the importance of follow-up, especially if the lump changes in size or symptoms worsen.
Educate on signs of complications such as increasing pain, fever, or inability to reduce a hernia, which would require immediate medical attention.

Diagnosis	Clinical Features	Diagnostic Tests	Management
Inguinal Hernia	Soft, reducible lump in the groin May enlarge with coughing or straining Usually painless unless incarcerated or strangulated	Clinical examination (positive cough impulse) Ultrasound if diagnosis is uncertain CT scan in complicated cases	Elective surgical repair for reducible hernia Emergency surgery for incarcerated/strangulated hernia
Femoral Hernia	Firm, tender lump in the groin, inferior to the inguinal ligament More common in women High risk of strangulation	Clinical examination Ultrasound or CT scan if needed	Urgent surgical repair due to risk of complications
Inguinal Lymphadenopathy	Enlarged, tender, or firm lymph nodes Associated with local or systemic infection, malignancy, or inflammatory diseases May be unilateral or bilateral	Full blood count, inflammatory markers Ultrasound-guided fine-needle aspiration or biopsy Consider testing for sexually transmitted infections (STIs) or tuberculosis	Treat underlying infection or cause Antibiotics if bacterial infection Oncology referral if malignancy is suspected
Femoral Artery Aneurysm	Pulsatile, expanding lump in the groin Possible distal ischaemia (leg pain, pallor) More common in older males	Doppler ultrasound CT angiography	Vascular surgery referral Surgical repair (open or endovascular)
Sebaceous Cyst	Non-painful, mobile lump under the skin May become infected, leading to redness and tenderness	Clinical examination Ultrasound if diagnosis is uncertain	Excision if symptomatic or infected Antibiotics if infected
Abscess	Painful, swollen lump, often red and warm to touch May be fluctuant with pus collection Fever and signs of infection	Clinical examination Ultrasound if needed to assess abscess size	Incision and drainage Antibiotics if systemic infection is present
Undescended Testicle (Cryptorchidism)	Absent testis from the scrotum Palpable lump in the inguinal canal More common in infants and young children	Clinical examination Ultrasound or MRI for undescended testis	Orchiopexy (surgical repositioning of the testicle)

PLEASE NOTE LEGAL ADVICE: The contents are under continuing development and improvements and may contain errors of omission or fact. Feedback vital and always welcome at drokane at gmail.com. This is not to be used for the assessment, diagnosis or management of patients. It should not be regarded as medical advice. It is only for educational purposes. Please adhere to your local protocols. If you are unwell please seek healthcare advice from your doctor. This does not replace senior or specialist advice. If you do not accept this then please do not use the website. If you need medical advice, please consult a doctor or other appropriate medical professional. If you are a medical professional and you need advice then speak to your senior or colleagues.

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