Differential Diagnosis for a 2-Month-Old Male Infant with a Lower Abdominal Protuberance
Single Most Likely Diagnosis
- Inguinal Hernia: This is the most likely diagnosis given the intermittent nature of the symptom, worsening with crying (which increases intra-abdominal pressure), and the presence of a lower abdominal protuberance. Inguinal hernias are common in infants, especially those born prematurely, due to the patency of the processus vaginalis.
Other Likely Diagnoses
- Hydrocele: A hydrocele could present similarly, with a scrotal swelling that may appear intermittent. However, it typically does not worsen with crying and is not usually associated with a palpable hernia.
- Cryptorchidism: While this condition involves the absence of one or both testes from the scrotum, it might not directly cause an intermittent abdominal protuberance. However, it could be considered if the physical examination findings suggest undescended testes.
Do Not Miss Diagnoses
- Femoral Hernia: Although less common than inguinal hernias, femoral hernias can occur in infants and may present with similar symptoms. They are more likely to become incarcerated, which is a surgical emergency.
- Lymphadenopathy: Enlarged lymph nodes in the groin area could potentially cause a palpable mass, but this would be less likely to be intermittent or worsen with crying. However, lymphadenopathy can be a sign of underlying infection or malignancy, making it crucial not to miss.
Rare Diagnoses
- Varicocele: This condition, characterized by an enlargement of the veins within the scrotum, is rare in infants and would not typically present as an intermittent abdominal protuberance.
- Other rare conditions such as abdominal wall defects or tumors could also present with a protuberance but would be less likely given the description and are not listed among the provided options.