• The most common differential diagnosis for a
bulge in the groin consists of the following:
• Undescended testis.
• A testicle in the groin may resemble a hernia; thus, it is imperative
to confirm the presence of the testis in the scrotum during initial
• A hydrocele is usually present at birth and can also be bilateral
in nature. It is generally described by the parents as a rapid swelling
of the scrotum that may cause the child discomfort if tense.
• With a communicating hydrocele, the swelling is most prominent
at the end of the day and reduces over night.
• On examination, a hydrocele is a soft, bluish, cystic swelling
within the scrotal sac that cannot be reduced.
• With a hydrocele, the spermatic cord should be able to be felt
at its upper limits unlike a hernia, whose upper margin is not clearly
defined and continues into the internal ring.
• Transillumination may help differentiate a hernia from a hydrocele.
• Hernias do not transilluminate as brightly as hydroceles.
• However, hernias can transilluminate if they are filled with
an air-filled loop.
• Simple hydroceles generally resolve by the age of ...