From the Guidelines
The initial management of a groin mass with peripheral vascularity on CT scan should include prompt surgical consultation, preferably with a general surgeon or urologist, as this finding is concerning for a potential inguinal hernia with compromised blood flow or a vascular mass that may require intervention. This approach is supported by the American College of Radiology Appropriateness Criteria for soft-tissue masses, which recommends radiographs as the initial imaging study for superficial palpable soft-tissue masses, but also acknowledges that for deep masses or lesions in areas difficult to evaluate radiographically, such as the groin, further evaluation with MRI or CT may be necessary 1.
Given the presence of peripheral vascularity on the CT scan, which suggests active blood flow to the periphery of the mass but potential compromise to central structures, timely surgical evaluation is essential to prevent complications such as tissue necrosis, perforation, or other complications. While awaiting surgical evaluation, the patient should be kept NPO (nothing by mouth) in case urgent surgery is needed. Pain management with appropriate analgesics such as acetaminophen 650-1000mg every 6 hours or, if more severe, opioid medications like hydrocodone/acetaminophen 5/325mg every 6 hours as needed should be provided.
Laboratory studies including complete blood count, basic metabolic panel, and coagulation studies should be obtained to assess for infection and prepare for possible surgical intervention. The patient should be monitored for signs of bowel obstruction (nausea, vomiting, abdominal distention) or ischemia (increasing pain, fever, tachycardia). The most recent guidelines from the American College of Radiology Appropriateness Criteria for soft tissue vascular anomalies support the use of MRI with and without IV contrast as a helpful initial imaging examination for vascular lesions such as tumors or malformations 1.
However, in the context of a groin mass with peripheral vascularity, the priority should be prompt surgical consultation to address potential complications, rather than further imaging studies. The use of MRI or CT with IV contrast may be beneficial in characterizing the type of lesion and guiding surgical intervention, but should not delay timely surgical evaluation.
From the Research
Initial Management of Groin Mass with Peripheral Vascularity
The initial management of a groin mass with peripheral vascularity as seen on a computed tomography (CT) scan involves a thorough understanding of the local anatomic characteristics of the groin and the various pathologic conditions that can occur in this region 2.
Classification of Groin Pathologic Conditions
Groin pathologic conditions can be classified into five major groups:
- Congenital abnormalities
- Noncongenital hernias
- Vascular conditions
- Infectious or inflammatory processes
- Neoplasms
Diagnostic Approach
A combination of clinical history, symptoms, laboratory values, and radiologic features can aid in accurately diagnosing mass lesions in the groin 3.
Imaging Modalities
Various imaging modalities, including ultrasound (US), CT, and magnetic resonance (MR) imaging, can be used to evaluate disease in the groin and upper thigh 4.
Key Considerations
Knowledge of the anatomy and specific pathology of the groin is essential for accurate diagnosis and management of groin masses 4, 3.
Potential Causes
The potential causes of a groin mass with peripheral vascularity include: