A lump in the groin is a common clinical presentation. Causes range from benign cysts to surgical emergencies such as strangulated hernia. A careful history, examination, and targeted investigations are essential to guide management. ⚠️ Always consider red-flag features such as severe pain, systemic sepsis, or irreducibility, which require urgent intervention.

🩺 Clinical History

Onset & Duration ⏳: When first noticed? Rapidly enlarging lumps are more concerning.
Pain 🤕: Painful lumps → abscess, lymphadenitis, strangulated hernia. Painless lumps → hernia, lipoma, aneurysm, cyst.
Changes with Activity 🏋️: Hernias enlarge with coughing, straining, or standing.
Systemic Symptoms 🌡️: Fever (infection), weight loss (malignancy), urinary/bowel changes (hernia complications or pelvic pathology).

👨‍⚕️ Physical Examination

Location 📍: Above inguinal ligament = inguinal hernia/lymph nodes; below = femoral hernia/aneurysm.
Consistency & Mobility 👐: Soft vs firm, reducible vs fixed.
Pulsatility ❤️: Suggests vascular lesion (femoral aneurysm).
Skin Changes 🔴: Erythema, warmth, ulceration → infection or malignancy.
Nearby Structures 🔍: Examine scrotum/testes, lower limbs for oedema, infection, or missing testicle (undescended).

🔎 Diagnostic Tests

Ultrasound 🖥️: First-line for hernia, cyst, lymphadenopathy, aneurysm.
CT/MRI 📸: For unclear cases, deep pelvic pathology, or malignancy staging.
Blood Tests 💉: FBC, CRP/ESR, STI screen if infection suspected.
Biopsy 🧫: Fine-needle aspiration (FNA) or excisional biopsy if suspicious for malignancy or lymphoma.

⚖️ Management Principles

Hernias: Elective repair if reducible; 🚨 emergency repair if strangulated.
Lymphadenopathy: Treat infection if present; oncology referral if malignant features.
Abscess: Incision + drainage ± antibiotics.
Aneurysms: Vascular surgery input for repair.
Benign cysts/lipomas: Excision if symptomatic or infected.

📚 Patient Education

Report red-flag symptoms: 🔴 sudden pain, fever, irreducible lump.
Encourage follow-up even if asymptomatic (especially hernias or lymphadenopathy).
Lifestyle advice: smoking cessation, weight management, safe sexual health practices.

📊 Differential Diagnosis of a Groin Lump

Diagnosis	Clinical Features	Key Tests	Management
Inguinal Hernia 🧳	Soft, reducible lump; enlarges with cough/strain; painless unless strangulated	Clinical exam, cough impulse; US/CT if uncertain	Elective repair if reducible; 🚨 emergency surgery if incarcerated/strangulated
Femoral Hernia 🚨	Firm, tender lump below inguinal ligament; more common in women; high strangulation risk	Clinical exam; US/CT for confirmation	Urgent surgical repair
Lymphadenopathy 🦠	Enlarged nodes (tender = infection; hard/fixed = malignancy)	FBC, ESR/CRP; US ± FNA/biopsy; STI/TB tests	Treat infection; oncology referral if suspicious
Femoral Artery Aneurysm ❤️	Pulsatile lump; may cause distal ischaemia (cold/pale leg)	Doppler US; CT angiography	Vascular surgery; repair (open or endovascular)
Sebaceous Cyst 💭	Mobile, subcutaneous lump; may become inflamed or infected	Clinical exam; US if uncertain	Excision if symptomatic; antibiotics if infected
Abscess 🔥	Red, warm, fluctuant, very tender; systemic sepsis possible	Clinical exam; US for size/depth	Incision & drainage ± antibiotics
Undescended Testis ⚽	Absent testis in scrotum; palpable lump in groin (infants/children)	Clinical exam; US/MRI for localisation	Orchiopexy (surgical repositioning)

💡 Exam Tip: Femoral hernias lie below the inguinal ligament and carry the highest risk of strangulation → always urgent surgical referral.

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Lump in Groin