Inguinal hernia differential diagnosis: Difference between revisions

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| style="background: #DCDCDC; padding: 5px; text-align: center;" |Testicular torsion
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Testicular torsion
| style="background: #F5F5F5; padding: 5px; text-align: center;"| +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;"| +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;"| +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;"|Scrotal
| style="background: #F5F5F5; padding: 5px; text-align: center;" |Scrotal
| style="background: #F5F5F5; padding: 5px; |'''Doppler ultrasonography:'''
| style="background: #F5F5F5; padding: 5px; " |'''Doppler ultrasonography:'''


enlargement, decreased echogenicity, and absent flow  
enlargement, decreased echogenicity, and absent flow  
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Epididymitis
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Epididymitis
| style="background: #F5F5F5; padding: 5px; text-align: center;"| +/-
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/-
| style="background: #F5F5F5; padding: 5px; text-align: center;"| +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;"| -
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
| style="background: #F5F5F5; padding: 5px; text-align: center;"|Scrotal
| style="background: #F5F5F5; padding: 5px; text-align: center;" |Scrotal
| style="background: #F5F5F5; padding: 5px; |'''Doppler ultrasonography:'''
| style="background: #F5F5F5; padding: 5px; " |'''Doppler ultrasonography:'''


enlarged (>17 mm) epididymis with a hypoechoic, hyperechoic, or heterogeneous echotexture, increased blood flow  
enlarged (>17 mm) epididymis with a hypoechoic, hyperechoic, or heterogeneous echotexture, increased blood flow  
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Hydrocele
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Hydrocele
| style="background: #F5F5F5; padding: 5px; text-align: center;"| +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;"| -
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
| style="background: #F5F5F5; padding: 5px; text-align: center;"| -
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
| style="background: #F5F5F5; padding: 5px; text-align: center;"|Inguinal
| style="background: #F5F5F5; padding: 5px; text-align: center;" |Inguinal
| style="background: #F5F5F5; padding: 5px; |'''Ultrasound:'''
| style="background: #F5F5F5; padding: 5px; " |'''Ultrasound:'''


simple fluid collection
simple fluid collection
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Varicocele
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Varicocele
| style="background: #F5F5F5; padding: 5px; text-align: center;"| +/-
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/-
| style="background: #F5F5F5; padding: 5px; text-align: center;"| +/-
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/-
| style="background: #F5F5F5; padding: 5px; text-align: center;"| +/-
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/-
| style="background: #F5F5F5; padding: 5px; text-align: center;"|Inguinal
| style="background: #F5F5F5; padding: 5px; text-align: center;" |Inguinal
| style="background: #F5F5F5; padding: 5px; |'''Ultrasonography:'''
| style="background: #F5F5F5; padding: 5px; " |'''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
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
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Spermatocele
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Spermatocele
| style="background: #F5F5F5; padding: 5px; text-align: center;"| +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;"| -
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
| style="background: #F5F5F5; padding: 5px; text-align: center;"|
| style="background: #F5F5F5; padding: 5px; text-align: center;" |
| style="background: #F5F5F5; padding: 5px; text-align: center;"|Inguinal
| style="background: #F5F5F5; padding: 5px; text-align: center;" |Inguinal
| style="background: #F5F5F5; padding: 5px; |'''Ultrasonography:''' hypoechoic with posterior acoustic enhancement
| style="background: #F5F5F5; padding: 5px; " |'''Ultrasonography:'''
hypoechoic with posterior acoustic enhancement


'''Color doppler ultrasonography:''' falling snow, resulting from internal echoes moving away from the transducer
'''Color doppler ultrasonography:'''  
 
falling snow, resulting from internal echoes moving away from the transducer
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Testicular tumor
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Testicular tumor
| style="background: #F5F5F5; padding: 5px; text-align: center;"| +/-
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/-
| style="background: #F5F5F5; padding: 5px; text-align: center;"| +/-
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/-
| style="background: #F5F5F5; padding: 5px; text-align: center;"| +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;"|Inguinal
| style="background: #F5F5F5; padding: 5px; text-align: center;" |Inguinal
| style="background: #F5F5F5; padding: 5px; |'''Ultrasonography:'''
| style="background: #F5F5F5; padding: 5px; " |'''Ultrasonography:'''


hypoechoic, smooth, round, and well-circumscribed mass
hypoechoic, smooth, round, and well-circumscribed mass
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Epididymal cyst
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Epididymal cyst
| style="background: #F5F5F5; padding: 5px; text-align: center;"| -
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
| style="background: #F5F5F5; padding: 5px; text-align: center;"| +/-
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/-
| style="background: #F5F5F5; padding: 5px; text-align: center;"| +/-
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/-
| style="background: #F5F5F5; padding: 5px; text-align: center;"|Inguinal
| style="background: #F5F5F5; padding: 5px; text-align: center;" |Inguinal
| style="background: #F5F5F5; padding: 5px; |'''Ultrasound:'''
| style="background: #F5F5F5; padding: 5px; " |'''Ultrasound:'''


posterior acoustic enhancement, well defined anechoic lesions, larger cysts may contain septations
posterior acoustic enhancement, well defined anechoic lesions, larger cysts may contain septations

Revision as of 18:21, 19 January 2018

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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]

Overview

Differentiating inguinal hernia from other Diseases

  • Inguinal hernia must be differentiated testicular torsion, epididymitis, hydrocele, varicocele, spermatocele, epididymal cyst and testicular tumor.

Preferred Table

Diseases Clinical features Imagings
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

Use if the above table can not be made

Differential Diagnosis Similar Features Differentiating Features
Differential 1
  • On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] also observed in [disease name].
  • On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] that distinguish it from [disease name].
Differential 2
  • On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] also observed in [disease name].
  • On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] that distinguish it from [disease name].
Differential 3
  • On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] also observed in [disease name].
  • On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] that distinguish it from [disease name].
Differential 4
  • On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] also observed in [disease name].
  • On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] that distinguish it from [disease name].
Differential 5
  • On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] also observed in [disease name].
  • On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] that distinguish it from [disease name].