Inguinal hernia differential diagnosis

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


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


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