Lump in groin

• Inguinal hernia: A protrusion of abdominal contents through the inguinal canal; more common in males, presenting as a reducible lump that may increase in size on coughing or straining.
• Femoral hernia: Protrusion through the femoral canal, more common in females; presents as a lump below the inguinal ligament and carries a higher risk of strangulation.
• Obturator hernia: A rare hernia through the obturator foramen, more common in elderly females; presents with a deep pelvic or groin mass, often with bowel obstruction.

• Reactive lymphadenopathy: Enlargement of lymph nodes due to infection or inflammation in the lower limb, genital region, or abdomen; nodes are typically tender, mobile, and soft.
• Malignant lymphadenopathy: Associated with lymphoma, metastatic cancer, or leukaemia; nodes are typically firm, non-tender, and may be fixed to underlying structures.
• Infectious causes: Includes tuberculosis, HIV, or sexually transmitted infections (e.g., syphilis, chancroid); may present with systemic symptoms such as fever and weight loss.

• Femoral aneurysm: A pulsatile mass in the groin due to dilatation of the femoral artery; may be associated with limb ischemia or embolism.
• Saphena varix: A dilated saphenous vein at the saphenofemoral junction; presents as a soft, compressible lump that may disappear on lying down.
• Varicose veins: Dilated superficial veins that may present as a lump in the groin; often associated with visible varicosities in the lower limb.

• Abscess: Localized collection of pus, often due to a bacterial infection; presents as a tender, fluctuant lump with erythema and warmth.
• Lymphogranuloma venereum: A sexually transmitted infection caused by Chlamydia trachomatis; presents with painful lymphadenopathy, often with ulceration or fistula formation.
• Furuncle or carbuncle: Skin infections involving hair follicles; presents as a painful, swollen lump with possible purulent discharge.

• Lipoma: A benign, soft, and mobile fatty tumor; usually painless and slow-growing.
• Soft tissue sarcoma: A rare malignant tumor of mesenchymal origin; presents as a painless, firm mass that may grow rapidly.
• Metastatic cancer: Secondary deposits from cancers such as melanoma, testicular, or gastrointestinal malignancies; nodes are often firm, fixed, and may be associated with systemic symptoms.

Acute onset may suggest an abscess, hernia, or vascular cause, while a more insidious onset may indicate a neoplastic or chronic infectious process.

• Pain: Suggestive of an abscess, lymphadenitis, or hernia; chronic, non-tender lumps may be neoplastic.
• Systemic symptoms: Fever, weight loss, and night sweats suggest an infectious or malignant process.
• Changes in size: A lump that varies in size with straining or position suggests a hernia or vascular cause.
• Ulceration or discharge: Indicative of an abscess or lymphogranuloma venereum.
• Pulsation: Suggests a vascular cause, such as a femoral aneurysm.

• Past medical history: Previous history of hernias, infections, or cancers is relevant.
• Drug history: Use of anticoagulants may predispose to hematoma formation, and immunosuppressants may increase the risk of infections or neoplasms.
• Family history: Consider a history of cancers, particularly if malignancy is suspected.
• Social history: Consider occupational exposures, sexual history (relevant for STIs), and travel history (relevant for infectious causes).

• Full blood count: To assess for infection, anemia, or other hematological abnormalities.
• Inflammatory markers (CRP, ESR): Elevated levels suggest infection or inflammation.
• Blood cultures: Indicated if systemic infection is suspected.
• Serology: For specific infections, such as HIV or syphilis, depending on clinical suspicion.

• Ultrasound: First-line imaging for evaluating the nature of the lump, particularly for hernias, abscesses, and vascular causes.
• CT scan: Provides detailed anatomical information, particularly useful in complex cases or where malignancy is suspected.
• MRI: Useful for soft tissue characterization and in cases where sarcoma or deep-seated tumors are suspected.
• Doppler ultrasound: Specifically indicated if a vascular cause, such as a femoral aneurysm or saphena varix, is suspected.

• Fine-needle aspiration (FNA) or biopsy: Indicated if malignancy, tuberculosis, or another specific diagnosis is suspected.
• Lymph node excision biopsy: May be required for definitive diagnosis if lymphoma or metastatic disease is suspected.
• Hernia exploration: Surgical exploration may be necessary for diagnostic confirmation and treatment.