Differential Diagnosis of Inguinal Hernia

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Undescended testis
The presence of a groin mass or underdeveloped hemiscrotum with absent testis on the affected side. Inguinal hernia is also associated with fully developed hemiscrotum and the bulge in the groin is associated with expansible cough impulse.

Differentiating point

  • Groin ultrasound scan is able to detect an undescended testis from an inguinal hernia. Other tests such as CT scan of the mass and MRI scan, are equally sensitive.

Femoral aneurysm
It is differentiated from inguinal hernia by the presence of pulsatile mass.

Differentiating point

  • Femoral artery aneurysm may be distinguished from inguinal hernia by a Doppler or Duplex scan that reveals blood flow.

Psoas abscess
It may be present with back pain and fever. Recent history of foreign travel or contact with someone with chronic cough, weight loss and night sweats are not uncommon.

Differentiating point

  • MRI and CT scan will show an abscess as an inflammatory mass within the psoas muscle.

Femoral hernia
Distinguishing between femoral and inguinal hernia is difficult. Femoral hernias are more common in females and more prone to strangulation. It is often preceded by a history of recent weight loss.

Differentiating point

  • Anatomical localisation by ultrasound, CT or MRI will show a femoral hernia lateral and below the pubic tubercle. An inguinal hernia is superomedial to the pubic tubercle.

Lipoma of the spermatic cord
Lipomas of the spermatic cord is often difficult to distinguish clinically from hernia.

Differentiating point

  • Ultrasound shows an echogenic solid mass.

Spermatocele
Cyst is mostly attached to the head of the epididymis. It often transilluminates on the examination.

Differentiating point

  • Investigation is usually not required.

Hydrocele of canal of Nuck
In females, if the processus vaginalis remains patent, it extends into the labium majus and is known as the canal of Nuck. It may easily be confused with inguinal hernia.

Differentiating point

  • Ultrasound shows a well-defined, cystic, hypoechogenic mass.