Disease/Condition Differentiating Signs/Symptoms Differentiating Tests

Undescended testis Presence of a groin mass, usually in children. Groin ultrasound scan can detect an undescended testis
Underdeveloped hemiscrotum with absent testis from an inguinal hernia. Other tests such as CT scan of
on the affected side. the mass and MRI scan, are equally sensitive.

Lymphadenopathy An enlarged lymph node may be associated with a Groin ultrasound scan can usually differentiate between
history of trauma, infection or malignancy. It is firm, lymphadenopathy and inguinal hernia.
tender, nonreducible, most often mimicking
femoral hernia.

Femoral hernia Femoral hernias are more common in slender,
often older females, and is more prone to
strangulation. It can be difficult to differentiate
between an incarcerated femoral hernia and
lymphadenitis.
Femoral hernia is located below the inguinal ligament,
lateral and inferior to the pubic tubercle. An inguinal hernia
bulge lies in the line of the inguinal ligament between the
anterior iliac spine and pubis.

Femoral aneurysm Presents as a pulsatile mass in the groin. Inguinal Femoral artery aneurysm may be distinguished from
hernia should not pulsate. normal transmitted femoral pulsation by Duplex
ultrasound scan.

Psoas abscess May present with back pain and fever. Recent MRI or CT scan will show an abscess as an inflammatory
history of foreign travel or contact with someone mass within the psoas muscle.
with chronic cough, weight loss and night sweats
are not uncommon.

Saphena varix Dilated great saphenous vein close to the Duplex ultrasound scan will show blood flow.
saphenofemoral junction because of incompetent
saphenofemoral valve. Often, there are signs
elsewhere of varicosity. Typically, it is soft,
compressible and, like inguinal hernia, it
disappears on lying supine. Vulvar varicosity in
Disease/Condition Differentiating Signs/Symptoms Differentiating Tests
women can present in similar fashion, mimicking a
hernia.

Hydrocele Primary hydrocele surrounds the testicle and is not Investigation is usually not required, but can be easily
in communication with the peritoneal cavity. confirmed by ultrasound.
Although rare in children, it is common in middle to
Hydrocele will often transilluminate with bright light.
old age. Testis and epididymis are not easily
defined. The absence of a mass at the external
ring above the swelling is the key differentiating
feature.

Encysted hydrocele of This is a rare form of hydrocele in which the Investigation is usually not required, but can be easily
the spermatic cord hydrocele that is separated from the peritoneal confirmed by ultrasound.
cavity and testis is associated with the spermatic
cord. Its presence may be confirmed clinically by
pulling down on the testicle and seeing the lump
follow.

Lipoma of the Lipoma of the cord is common and may be difficult Ultrasound shows an echogenic solid mass, often
spermatic cord to distinguish clinically from hernia. Clinically, it misinterpreted as a fat-containing hernia. CT shows fat in
does not have an impulse and does not enlarge the inguinal canal.
with Valsalva maneuver.

Spermatocele Cyst attached to the head of the epididymis. Investigation is usually not required.
Smooth and able to get above it on examination.
Spermatocele will often transilluminate with bright light.

Hydrocele of canal of In females, if the processus vaginalis remains Ultrasound shows a well-defined, cystic, hypoechogenic
Nuck patent, it extends into the labium majus and is mass.
known as the canal of Nuck. When it contains fluid,
it presents as an inguinal mass. It may easily be
Disease/Condition Differentiating Signs/Symptoms Differentiating Tests
confused with inguinal hernia. In symptomatic
patients, the surgical treatment is the same.