Femoral hernia differential diagnosis: Difference between revisions

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__NOTOC__
__NOTOC__
{{Femoral hernia}}
[[Image:Home_logo1.png|right|250px|link=https://www.wikidoc.org/index.php/Femoral_hernia]]
{{CMG}}; {{AE}} {{MKA}}  
{{CMG}}; {{AE}} {{MKA}}  


==Overview==
==Overview==
[Disease name] must be differentiated from other diseases that cause [clinical feature 1], [clinical feature 2], and [clinical feature 3], such as [differential dx1], [differential dx2], and [differential dx3].
Femoral hernia must be differentiated from other [[diseases]] that cause [[swelling]] in the [[groin area]], such as [[inguinal hernia]], [[femoral artery]] [[aneurysm]], [[saphenous vein]] varicosity, [[lymphadenopathy]] and [[lipoma]].


OR
==Differentiating femoral hernia from other diseases==
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>


[Disease name] must be differentiated from [[differential dx1], [differential dx2], and [differential dx3].
==Differentiating X from other Diseases==
*[Disease name] must be differentiated from other diseases that cause [clinical feature 1], [clinical feature 2], and [clinical feature 3], such as [differential dx1], [differential dx2], and [differential dx3].
*[Disease name] must be differentiated from [[differential dx1], [differential dx2], and [differential dx3].
*As [disease name] manifests in a variety of clinical forms, differentiation must be established in accordance with the particular subtype. [Subtype name 1] must be differentiated from other diseases that cause [clinical feature 1], such as [differential dx1] and [differential dx2]. In contrast, [subtype name 2] must be differentiated from other diseases that cause [clinical feature 2], such as [differential dx3] and [differential dx4].
===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="5" |History and Symptoms
! colspan="5" |History and Symptoms
! colspan="2" |Physical Examination
!
!
! colspan="4" |Physical Examination
!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;"
!Swelling
!Swelling
Line 31: Line 22:
!Vomiting
!Vomiting
!Age/Gender
!Age/Gender
!Location
!Location of swelling
!Physical Finding 1
!Tenderness
!Physical Finding 2
!Pulsatile mass
!Physical Finding 3
!Physical Finding 4
!Ultrasonography
!Ultrasonography
!Lab Test 2
!Lab Test 3
!Lab Test 4
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Femoral hernia
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Femoral hernia
| style="background: #F5F5F5; padding: 5px;" |<nowiki>+</nowiki>
| 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;" |+/-
| style="background: #F5F5F5; padding: 5px;" | +/-
|Female  > 45yrs
| style="background: #F5F5F5; padding: 5px;" | +/-
|Below the inguinal ligament
| 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: #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;" |
| 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;" |Inguinal hernia
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Femoral artery]] [[aneurysm]]
| style="background: #F5F5F5; padding: 5px;" |
| 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;" | -
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | -
|
|Above the inguinal ligament
| 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;" |Abnormal ballooning of the anteroposterior diameter of the inguinal canal
| 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
* > 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;" |Femoral artery aneurysm
| 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;" |-
| style="background: #F5F5F5; padding: 5px;" |<nowiki>+/-</nowiki>
| style="background: #F5F5F5; padding: 5px;" |-
| style="background: #F5F5F5; padding: 5px;" |<nowiki>-</nowiki>
| style="background: #F5F5F5; padding: 5px;" |-
| 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;" |
| style="background: #F5F5F5; padding: 5px;" |Duplex ultrasound used to differentiate between femoral artery aneurysm and femoral 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;" |
* 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;" |Saphenous vein varicosity
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Lymphadenopathy]]
|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
|
|
|
|
|
|
|
|
|
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Lymphadenopathy
| style="background: #F5F5F5; padding: 5px;" |<nowiki>+</nowiki>
| 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;" | -
| 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;" |Internal echo in cases of lymphadenopathy
| 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 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: #DCDCDC; padding: 5px; text-align: center;" |[[Lipoma]]
| style="background: #F5F5F5; padding: 5px;" |<nowiki>+</nowiki>
| 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;" | -
| style="background: #F5F5F5; padding: 5px;" |-
| 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;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |Echogenic solid mass, often misinterpreted as a fat containing 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 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==
{{Reflist|2}}
{{Reflist|2}}


[[Category:Medicine]]
[[Category:Surgery]]
[[Category:Gastroenterology]]
[[Category:Gastroenterology]]
[[Category:Up-To-Date]]
[[Category:Up-To-Date]]
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[[Category:Primary care]]
[[Category:Emergency medicine]]




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{{WS}}
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Latest revision as of 16:13, 19 August 2020

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

Overview

Femoral hernia must be differentiated from other diseases that cause swelling in the groin area, such as inguinal hernia, femoral artery aneurysm, saphenous vein varicosity, lymphadenopathy and lipoma.

Differentiating femoral hernia from other diseases

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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