Varicose veins differential diagnosis: Difference between revisions

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Femoral hernia must be differentiated from other diseases that cause [[swelling]] in the [[groin area]]. The differentials include the following:<ref name="DiwanSarkar2000">{{cite journal|last1=Diwan|first1=Aparna|last2=Sarkar|first2=Rajabrata|last3=Stanley|first3=James C.|last4=Zelenock|first4=Gerald B.|last5=Wakefield|first5=Thomas W.|title=Incidence of femoral and popliteal artery aneurysms in patients with abdominal aortic aneurysms|journal=Journal of Vascular Surgery|volume=31|issue=5|year=2000|pages=863–869|issn=07415214|doi=10.1067/mva.2000.105955}}</ref><ref name="pmid1433668">{{cite journal |vauthors=Rigdon EE, Monajjem N |title=Aneurysms of the superficial femoral artery: a report of two cases and review of the literature |journal=J. Vasc. Surg. |volume=16 |issue=5 |pages=790–3 |year=1992 |pmid=1433668 |doi= |url=}}</ref><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="pmid26987468">{{cite journal |vauthors=Berger D |title=Evidence-Based Hernia Treatment in Adults |journal=Dtsch Arztebl Int |volume=113 |issue=9 |pages=150–7; quiz 158 |year=2016 |pmid=26987468 |pmc=4802357 |doi=10.3238/arztebl.2016.0150 |url=}}</ref><ref name="YehLehr-Janus1984">{{cite journal|last1=Yeh|first1=Hsu-Chong|last2=Lehr-Janus|first2=Cynthia|last3=Cohen|first3=Burton A.|last4=Rabinowitz|first4=Jack G.|title=Ultrasonography and CT of abdominal and inguinal hernias|journal=Journal of Clinical Ultrasound|volume=12|issue=8|year=1984|pages=479–486|issn=00912751|doi=10.1002/jcu.1870120805}}</ref><ref name="pmid25489584">{{cite journal |vauthors=Yang XF, Liu JL |title=Acute incarcerated external abdominal hernia |journal=Ann Transl Med |volume=2 |issue=11 |pages=110 |year=2014 |pmid=25489584 |pmc=4245506 |doi=10.3978/j.issn.2305-5839.2014.11.05 |url=}}</ref><ref name="pmid1561184">{{cite journal| author=Corder AP| title=The diagnosis of femoral hernia. | journal=Postgrad Med J | year= 1992 | volume= 68 | issue= 795 | pages= 26-8 | pmid=1561184 | doi= | pmc=2399298 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1561184  }} </ref><ref name="primary surgery">{{cite book | last = King | first = Maurice | title = Primary surgery | publisher = Oxford University Press | location = Oxford New York | year = 1987 | isbn = 0192616943 }}</ref><ref name="pmid25693015">{{cite journal| author=Fitzgibbons RJ, Forse RA| title=Clinical practice. Groin hernias in adults. | journal=N Engl J Med | year= 2015 | volume= 372 | issue= 8 | pages= 756-63 | pmid=25693015 | doi=10.1056/NEJMcp1404068 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25693015 }} </ref><ref name="pmid21250263">{{cite journal |vauthors=Walker HK, Hall WD, Hurst JW, Amerson JR |title= |journal= |volume= |issue= |pages= |year= |pmid=21250263 |doi= |url=}}</ref><ref name="pmid21326691">{{cite journal |vauthors=Khilnani NM, Min RJ |title=Imaging of venous insufficiency |journal=Semin Intervent Radiol |volume=22 |issue=3 |pages=178–84 |year=2005 |pmid=21326691 |pmc=3036278 |doi=10.1055/s-2005-921950 |url=}}</ref><ref name="pmid1646225">{{cite journal |vauthors=Fornage BD, Tassin GB |title=Sonographic appearances of superficial soft tissue lipomas |journal=J Clin Ultrasound |volume=19 |issue=4 |pages=215–20 |year=1991 |pmid=1646225 |doi= |url=}}</ref><ref name="pmid24648376">{{cite journal |vauthors=Mirjalili SA, Muirhead JC, Stringer MD |title=Redefining the surface anatomy of the saphenofemoral junction in vivo |journal=Clin Anat |volume=27 |issue=6 |pages=915–9 |year=2014 |pmid=24648376 |doi=10.1002/ca.22386 |url=}}</ref>
 
{|
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
! rowspan="2" |Diseases
! colspan="5" |History and Symptoms
! colspan="2" |Physical Examination
!
!Imaging
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
!Swelling
!Pain
!Nausea
!Vomiting
!Age/Gender
!Location of swelling
!Tenderness
!Pulsatile mass
!Ultrasonography
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Femoral hernia
| style="background: #F5F5F5; padding: 5px;" |<nowiki>+</nowiki>
| style="background: #F5F5F5; padding: 5px;" | +/-
| style="background: #F5F5F5; padding: 5px;" | +/-
| style="background: #F5F5F5; padding: 5px;" | +/-
| style="background: #F5F5F5; padding: 5px;" |
* Female  
* > 45yrs
| style="background: #F5F5F5; padding: 5px;" |Below the [[inguinal ligament]]
| style="background: #F5F5F5; padding: 5px;" | +/-<sup>†</sup>
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |Slightly [[echogenic]], long strip shaped [[omentum]] in the [[hernia]] sac. In cases of [[Incarcerated hernia|incarceration]], expansion of a fluid filled [[bowel]], [[intestinal]] fluid reflux and thickening and [[edema]] of [[intestinal wall]].
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Inguinal hernia]]
| 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;" |
* Male
* > 40yrs
| style="background: #F5F5F5; padding: 5px;" |Above the [[inguinal ligament]]
| style="background: #F5F5F5; padding: 5px;" | +/-<sup>†</sup>
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |Abnormal ballooning of the [[anteroposterior]] diameter of the [[inguinal canal]]
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Femoral artery]] [[aneurysm]]
| style="background: #F5F5F5; padding: 5px;" |<nowiki>+</nowiki>
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |
* Male
* > 60 yrs
| style="background: #F5F5F5; padding: 5px;" |Usually below the [[inguinal ligament]] 
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |[[Duplex ultrasound]] used to differentiate between [[femoral artery]] [[aneurysm]] and femoral hernia
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Saphenous vein]] varicosity
| style="background: #F5F5F5; padding: 5px;" |<nowiki>+</nowiki>
| style="background: #F5F5F5; padding: 5px;" |<nowiki>+/-</nowiki>
| style="background: #F5F5F5; padding: 5px;" |<nowiki>-</nowiki>
| style="background: #F5F5F5; padding: 5px;" |<nowiki>-</nowiki>
| style="background: #F5F5F5; padding: 5px;" |
* Female
| style="background: #F5F5F5; padding: 5px;" |Sephanofemoral junction (inferolateral to the [[pubic tubercle]])
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |[[Duplex ultrasound]] determines the pattern of [[venous]] incompetence and [[reflux]].
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Lymphadenopathy]]
| style="background: #F5F5F5; padding: 5px;" |<nowiki>+</nowiki>
| style="background: #F5F5F5; padding: 5px;" | +/-
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |
* Male and female
| style="background: #F5F5F5; padding: 5px;" |[[Femoral canal]] ([[medial]] to [[Femoral artery|femoral vessels]])
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |Internal echo in cases of [[lymphadenopathy]]
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Lipoma]]
| style="background: #F5F5F5; padding: 5px;" |<nowiki>+</nowiki>
| style="background: #F5F5F5; padding: 5px;" | +/-
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |
* Male and female
* 40-60 yrs
| style="background: #F5F5F5; padding: 5px;" |Occurs any where throughout the body
| style="background: #F5F5F5; padding: 5px;" | +/-
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |[[Echogenic]] solid [[Mass (medicine)|mass]], often misinterpreted as a [[fat]] containing [[hernia]].
|}
 
'''†'''In cases of incarceration or [[strangulation]], [[tenderness]] can be present.
 


==References==
==References==

Revision as of 15:21, 30 July 2018

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Femoral hernia must be differentiated from other diseases that cause swelling in the groin area. The differentials include the following:[1][2][3][4][5][6][7][8][9][10][11][12][13]

Diseases History and Symptoms Physical Examination Imaging
Swelling Pain Nausea Vomiting Age/Gender Location of swelling Tenderness Pulsatile mass Ultrasonography
Femoral hernia + +/- +/- +/-
  • Female
  • > 45yrs
 Below the inguinal ligament +/-† - Slightly echogenic, long strip shaped omentum in the hernia sac. In cases of incarceration, expansion of a fluid filled bowel, intestinal fluid reflux and thickening and edema of intestinal wall.
Inguinal hernia + + +/- +/-
  • Male
  • > 40yrs
 Above the inguinal ligament +/-† - Abnormal ballooning of the anteroposterior diameter of the inguinal canal
Femoral artery aneurysm + - - -
  • Male
  • > 60 yrs
 Usually below the inguinal ligament - + Duplex ultrasound used to differentiate between femoral artery aneurysm and femoral hernia
Saphenous vein varicosity + +/- - -
  • Female
 Sephanofemoral junction (inferolateral to the pubic tubercle) - - Duplex ultrasound determines the pattern of venous incompetence and reflux.
Lymphadenopathy + +/- - -
  • Male and female
 Femoral canal (medial to femoral vessels) - - Internal echo in cases of lymphadenopathy
Lipoma + +/- - -
  • Male and female
  • 40-60 yrs
 Occurs any where throughout the body +/- - Echogenic solid mass, often misinterpreted as a fat containing hernia.

†In cases of incarceration or strangulation, tenderness can be present.


References

  1. ↑ Diwan, Aparna; Sarkar, Rajabrata; Stanley, James C.; Zelenock, Gerald B.; Wakefield, Thomas W. (2000). "Incidence of femoral and popliteal artery aneurysms in patients with abdominal aortic aneurysms". Journal of Vascular Surgery. 31 (5): 863–869. doi:10.1067/mva.2000.105955. ISSN 0741-5214.
  2. ↑ Rigdon EE, Monajjem N (1992). "Aneurysms of the superficial femoral artery: a report of two cases and review of the literature". J. Vasc. Surg. 16 (5): 790–3. PMID 1433668.
  3. ↑ Jenkins JT, O'Dwyer PJ (2008). "Inguinal hernias". BMJ. 336 (7638): 269–72. doi:10.1136/bmj.39450.428275.AD. PMC 2223000. PMID 18244999.
  4. ↑ Berger D (2016). "Evidence-Based Hernia Treatment in Adults". Dtsch Arztebl Int. 113 (9): 150–7, quiz 158. doi:10.3238/arztebl.2016.0150. PMC 4802357. PMID 26987468.
  5. ↑ Yeh, Hsu-Chong; Lehr-Janus, Cynthia; Cohen, Burton A.; Rabinowitz, Jack G. (1984). "Ultrasonography and CT of abdominal and inguinal hernias". Journal of Clinical Ultrasound. 12 (8): 479–486. doi:10.1002/jcu.1870120805. ISSN 0091-2751.
  6. ↑ Yang XF, Liu JL (2014). "Acute incarcerated external abdominal hernia". Ann Transl Med. 2 (11): 110. doi:10.3978/j.issn.2305-5839.2014.11.05. PMC 4245506. PMID 25489584.
  7. ↑ Corder AP (1992). "The diagnosis of femoral hernia". Postgrad Med J. 68 (795): 26–8. PMC 2399298. PMID 1561184.
  8. ↑ King, Maurice (1987). Primary surgery. Oxford New York: Oxford University Press. ISBN 0192616943.
  9. ↑ Fitzgibbons RJ, Forse RA (2015). "Clinical practice. Groin hernias in adults". N Engl J Med. 372 (8): 756–63. doi:10.1056/NEJMcp1404068. PMID 25693015.
  10. ↑ Walker HK, Hall WD, Hurst JW, Amerson JR. PMID 21250263. Missing or empty |title= (help)
  11. ↑ Khilnani NM, Min RJ (2005). "Imaging of venous insufficiency". Semin Intervent Radiol. 22 (3): 178–84. doi:10.1055/s-2005-921950. PMC 3036278. PMID 21326691.
  12. ↑ Fornage BD, Tassin GB (1991). "Sonographic appearances of superficial soft tissue lipomas". J Clin Ultrasound. 19 (4): 215–20. PMID 1646225.
  13. ↑ Mirjalili SA, Muirhead JC, Stringer MD (2014). "Redefining the surface anatomy of the saphenofemoral junction in vivo". Clin Anat. 27 (6): 915–9. doi:10.1002/ca.22386. PMID 24648376.

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