Femoral hernia differential diagnosis
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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]
| Diseases | History and Symptoms | Physical Examination | Imaging | ||||||
|---|---|---|---|---|---|---|---|---|---|
| Swelling | Pain | Nausea | Vomiting | Age/Gender | Location of swelling | Tenderness | Pulsatile mass | Ultrasonography | |
| Femoral hernia | + | +/- | +/- | +/- |
|
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 | + | + | +/- | +/- |
|
Above the inguinal ligament | +/-† | - | Abnormal ballooning of the anteroposterior diameter of the inguinal canal |
| Femoral artery aneurysm | + | - | - | - |
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Usually below the inguinal ligament | - | + | Duplex ultrasound used to differentiate between femoral artery aneurysm and femoral hernia |
| Saphenous vein varicosity | + | +/- | - | - |
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Sephanofemoral junction | - | - | Duplex ultrasound determines the pattern of venous incompetence and reflux. |
| Lymphadenopathy | + | +/- | - | - |
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Femoral canal | - | - | Internal echo in cases of lymphadenopathy |
| Lipoma | + | +/- | - | - |
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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
- ↑ 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.
- ↑ 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.
- ↑ Jenkins JT, O'Dwyer PJ (2008). "Inguinal hernias". BMJ. 336 (7638): 269–72. doi:10.1136/bmj.39450.428275.AD. PMC 2223000. PMID 18244999.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ Corder AP (1992). "The diagnosis of femoral hernia". Postgrad Med J. 68 (795): 26–8. PMC 2399298. PMID 1561184.
- ↑ King, Maurice (1987). Primary surgery. Oxford New York: Oxford University Press. ISBN 0192616943.
- ↑ 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.
- ↑ Walker HK, Hall WD, Hurst JW, Amerson JR. PMID 21250263. Missing or empty
|title=(help) - ↑ 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.
- ↑ Fornage BD, Tassin GB (1991). "Sonographic appearances of superficial soft tissue lipomas". J Clin Ultrasound. 19 (4): 215–20. PMID 1646225.