Lumps in the groin: Differential diagnosis Inguinal hernia, femoral hernia, enlarged lymph nodes, saphena varix, hydrocele of the cord (or of the canal of Neck in women), vaginal hydrocele, undescended testis, lipoma of the cord, femoral aneurysm, psoas abscess. Determining the diagnosis Hernia A hernia (usually) has a cough impulse (i.e. it expands on coughing) and (usually) reduces with direct pressure or on lying down unless, uncommonly, it is incarcerated (i.e. the contents of the hernia are fixed in the hernia sac by their size and by adhesions). Movement of the lump is not the same as expansion . Many groin lumps have a transmitted impulse on coughing (i.e. they move) but do not expand on coughing. Since inguinal and femoral hernias arise from within the abdomen and descend into the groin, it is not possible to get above them. For lumps that arise from within the scrotum, the superior edge can be palpated (i.e. it is possible to get above them). Once a
