Inguinal hernia differential diagnosis: Difference between revisions

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__NOTOC__
[[Image:Home_logo1.png|right|250px|link=https://www.wikidoc.org/index.php/Inguinal_hernia]]
{{CMG}}; {{AE}} {{F.K}}
==Overview==
Inguinal hernia must be differentiated testicular torsion, [[epididymitis]], [[hydrocele]], [[varicocele]], [[spermatocele]], [[epididymal cyst]] and [[testicular tumor]].
==Differentiating inguinal hernia from other Diseases==
==Differentiating inguinal hernia from other Diseases==
*Inguinal hernia must be differentiated from femoral hernia, epididymitis, testicular torsion, lipomas,inguinal adenopathy, groin abscess, saphena varix, vascular aneurysm or pseudoaneurysm, hydrocele, varicocele, cryptorchidism.
*Inguinal hernia must be differentiated testicular torsion, [[epididymitis]], [[hydrocele]], [[varicocele]], [[spermatocele]], [[epididymal cyst]] and [[testicular tumor]].<ref name="pmid18244999">{{cite journal |vauthors=Jenkins JT, O'Dwyer PJ |title=Inguinal hernias |journal=BMJ |volume=336 |issue=7638 |pages=269–72 |year=2008 |pmid=18244999 |pmc=2223000 |doi=10.1136/bmj.39450.428275.AD |url=}}</ref><ref name="pmid14724878">{{cite journal |vauthors=Perrott CA |title=Inguinal hernias: room for a better understanding |journal=Am J Emerg Med |volume=22 |issue=1 |pages=48–50 |year=2004 |pmid=14724878 |doi= |url=}}</ref><ref name="pmid18029925">{{cite journal |vauthors=Oh SN, Jung SE, Rha SE, Lim GY, Ku YM, Byun JY, Lee JM |title=Sonography of various cystic masses of the female groin |journal=J Ultrasound Med |volume=26 |issue=12 |pages=1735–42 |year=2007 |pmid=18029925 |doi= |url=}}</ref><ref name="pmid17460003">{{cite journal |vauthors=Yang DM, Kim HC, Lim JW, Jin W, Ryu CW, Kim GY, Cho H |title=Sonographic findings of groin masses |journal=J Ultrasound Med |volume=26 |issue=5 |pages=605–14 |year=2007 |pmid=17460003 |doi= |url=}}</ref>


===Preferred Table===
{|
{|
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
! rowspan="2" |Diseases
! rowspan="2" |Diseases
! colspan="4" |History and Symptoms
! colspan="4" |Clinical features
! colspan="4" |Physical Examination
! rowspan="2" |Imaging
! colspan="4" |Laboratory Findings
! rowspan="2" |Other Findings
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
!Finding
!Swelling
1
!Pain
!Finding 2
!Mass
!Finding 3
!Inguinal or scrotal
!Finding
4
!Physical Finding 1
!Physical Finding 2
!Physical Finding 3
!Physical Finding 4
!Lab Test 1
!Lab Test 2
!Lab Test 3
!Lab Test 4
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Differential Diagnosis 1
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Testicular torsion]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px;" |<nowiki>+</nowiki>
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px; text-align: center;" |Scrotal
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px; " |'''Doppler ultrasonography:'''
| style="background: #F5F5F5; padding: 5px;" |
 
| style="background: #F5F5F5; padding: 5px;" |
enlargement, decreased echogenicity, and absent flow
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Differential Diagnosis 2
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Epididymitis]]
| style="background: #F5F5F5; padding: 5px;" |'''↑'''
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/-
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px; text-align: center;" |Scrotal
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px; " |'''Doppler ultrasonography:'''
| style="background: #F5F5F5; padding: 5px;" |
 
| style="background: #F5F5F5; padding: 5px;" |
enlarged (>17 mm) [[epididymis]] with a hypoechoic, hyperechoic, or [[heterogeneous]] echotexture, increased blood flow
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Differential Diagnosis 3
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Hydrocele]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px;" |↓
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px; text-align: center;" |[[Inguinal]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px; " |'''Ultrasound:'''
| style="background: #F5F5F5; padding: 5px;" |
 
| style="background: #F5F5F5; padding: 5px;" |
simple fluid collection
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Differential Diagnosis 4
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Varicocele]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/-
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/-
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/-
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px; text-align: center;" |[[Inguinal]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px; " |'''Ultrasonography:'''
| style="background: #F5F5F5; padding: 5px;" |
[[tortuous]], [[tubular]], anechoic structures adjacent to the testis corresponding to dilated veins of the [[pampiniform plexus]] with calibers of 2–3 mm during the [[Valsalva maneuver]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Differential Diagnosis 5
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Spermatocele]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/-
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px; text-align: center;" |[[Inguinal]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px; " |'''Ultrasonography:'''
| style="background: #F5F5F5; padding: 5px;" |
hypoechoic with posterior acoustic enhancement
| style="background: #F5F5F5; padding: 5px;" |
 
| style="background: #F5F5F5; padding: 5px;" |
'''Color doppler ultrasonography:'''
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|}


===Use if the above table can not be made===
falling snow, resulting from internal echoes moving away from the transducer
{| style="border: 0px; font-size: 90%; margin: 3px; width: 1000px" align="center"
| valign="top" |
|+
! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Differential Diagnosis}}
! style="background: #4479BA; width: 300px;" | {{fontcolor|#FFF|Similar Features}}
! style="background: #4479BA; width: 300px;" | {{fontcolor|#FFF|Differentiating Features}}
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |Differential 1
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Testicular tumor]]
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/-
* On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] also observed in [disease name].
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/-
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
* On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] that distinguish it from [disease name].
| style="background: #F5F5F5; padding: 5px; text-align: center;" |[[Inguinal]]
| style="background: #F5F5F5; padding: 5px; " |'''Ultrasonography:'''
 
hypoechoic, smooth, round, and well-circumscribed mass
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |Differential 2
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Epididymal cyst]]
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
* On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] also observed in [disease name].
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/-
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/-
* On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] that distinguish it from [disease name].
| style="background: #F5F5F5; padding: 5px; text-align: center;" |[[Inguinal]]
|-
| style="background: #F5F5F5; padding: 5px; " |'''Ultrasound:'''
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |Differential 3
 
| style="padding: 5px 5px; background: #F5F5F5;" |
posterior acoustic enhancement, well defined anechoic lesions, larger cysts may contain septations
* On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] also observed in [disease name].
| style="padding: 5px 5px; background: #F5F5F5;" |
* On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] that distinguish it from [disease name].
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |Differential 4
| style="padding: 5px 5px; background: #F5F5F5;" |
* On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] also observed in [disease name].
| style="padding: 5px 5px; background: #F5F5F5;" |
* On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] that distinguish it from [disease name].
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |Differential 5
| style="padding: 5px 5px; background: #F5F5F5;" |
* On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] also observed in [disease name].
| style="padding: 5px 5px; background: #F5F5F5;" |
* On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] that distinguish it from [disease name].
|}
|}
== References ==
{{Reflist|2}}

Latest revision as of 20:44, 13 February 2019

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Farima Kahe M.D. [2]

Overview

Inguinal hernia must be differentiated testicular torsion, epididymitis, hydrocele, varicocele, spermatocele, epididymal cyst and testicular tumor.

Differentiating inguinal hernia from other Diseases

Diseases Clinical features Imaging
Swelling Pain Mass Inguinal or scrotal
Testicular torsion + + + Scrotal Doppler ultrasonography:

enlargement, decreased echogenicity, and absent flow

Epididymitis +/- + - Scrotal Doppler ultrasonography:

enlarged (>17 mm) epididymis with a hypoechoic, hyperechoic, or heterogeneous echotexture, increased blood flow

Hydrocele + - - Inguinal Ultrasound:

simple fluid collection

Varicocele +/- +/- +/- Inguinal Ultrasonography:

tortuous, tubular, anechoic structures adjacent to the testis corresponding to dilated veins of the pampiniform plexus with calibers of 2–3 mm during the Valsalva maneuver

Spermatocele + - +/- Inguinal Ultrasonography:

hypoechoic with posterior acoustic enhancement

Color doppler ultrasonography:

falling snow, resulting from internal echoes moving away from the transducer

Testicular tumor +/- +/- + Inguinal Ultrasonography:

hypoechoic, smooth, round, and well-circumscribed mass

Epididymal cyst - +/- +/- Inguinal Ultrasound:

posterior acoustic enhancement, well defined anechoic lesions, larger cysts may contain septations

References

  1. ↑ Jenkins JT, O'Dwyer PJ (2008). "Inguinal hernias". BMJ. 336 (7638): 269–72. doi:10.1136/bmj.39450.428275.AD. PMC 2223000. PMID 18244999.
  2. ↑ Perrott CA (2004). "Inguinal hernias: room for a better understanding". Am J Emerg Med. 22 (1): 48–50. PMID 14724878.
  3. ↑ Oh SN, Jung SE, Rha SE, Lim GY, Ku YM, Byun JY, Lee JM (2007). "Sonography of various cystic masses of the female groin". J Ultrasound Med. 26 (12): 1735–42. PMID 18029925.
  4. ↑ Yang DM, Kim HC, Lim JW, Jin W, Ryu CW, Kim GY, Cho H (2007). "Sonographic findings of groin masses". J Ultrasound Med. 26 (5): 605–14. PMID 17460003.
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