EMQs in Clinical Medicine.pdf - Peshawar Medical College

Lumps in the groin – answers 177
G
A parent brings a 4-year-old boy to clinic with a large swelling at the
base of the posterior triangle. The swelling is soft and fluctuant and
transilluminates brilliantly.
A cystic hygroma is a congenital collection of lymphatic sacs. The
distinctive sign is the brilliant transilluminance.
63 Lumps in the groin
Answers: G E A J B
G
E
A
J
B
A 45-year-old woman presents with an irreducible lump in the left
groin that is positioned below and lateral to the pubic tubercle.
Femoral hernias are palpable below and lateral to the pubic tubercle,
whereas inguinal hernias can be felt above and medial to this landmark.
Femoral hernias are often irreducible and likely to strangulate.
A 26-year-old man presents after surgery with a reducible lump in
the left groin above and medial to the pubic tubercle. The lump is not
controlled after reduction by pressure over the internal inguinal ring.
Direct hernias push directly through the posterior wall of the inguinal
canal and thus pressure over the internal ring after reduction will not
stop it popping back through the wall. They often reduce easily and
rarely strangulate.
A 40-year-old man presents with a swelling in the right groin that
descends into the scrotum. It can be controlled after reduction by
pressure over the internal inguinal ring.
Indirect inguinal hernias pass through the internal inguinal ring and
therefore can be controlled by pressure over the internal inguinal ring
after the hernia has been reduced. Generally speaking, direct inguinal
hernias are not felt in the scrotum.
A 55-year-old woman presents with a soft lump in her left groin.
There is an expansile cough impulse and a fluid thrill is felt when
percussing lower down the leg.
This is a compressible dilatation at the top of the saphenous vein.
A 60-year-old smoker complains of a throbbing lump in his right
groin. Examination reveals an expansile pulsation in the mass.
Direct pressure of a femoral aneurysm on the femoral vein can lead to
venous obstruction and thrombosis. Common femoral artery aneurysms
are usually caused by atherosclerotic disease. However, a false aneurysm
can be caused via trauma, e.g. a stab wound to the artery. For example, if
a patient is stabbed in the femoral artery, a haematoma develops outside
the artery and eventually a thrombus occludes the hole in the arterial wall.