Differential Diagnosis for a Loud and Continuous Crying Infant with Firm Hot Tender Bluish Inguinal Mass

• Single Most Likely Diagnosis
  • Irreducible Inguinal Hernia: This condition is highly likely given the description of a firm, hot, tender, and bluish inguinal mass. An irreducible inguinal hernia, especially if it has become incarcerated or strangulated, can cause severe pain and the described physical findings, leading to continuous crying in an infant.
• Other Likely Diagnoses
  • Testicular Torsion: Although less common in infants, testicular torsion can present with a firm, tender, and possibly bluish mass if the torsion is severe and compromises blood flow. The pain from testicular torsion can cause significant distress, leading to continuous crying.
• Do Not Miss Diagnoses
  • Appendiceal Torsion: Although rare and less likely given the inguinal location of the mass, appendiceal torsion or any condition leading to appendicitis can present with severe abdominal pain that might radiate or be perceived in the groin area, especially in infants where the appendix is not always in its typical location. Missing this diagnosis could lead to severe consequences, including perforation and peritonitis.
• Rare Diagnoses
  • Other rare conditions such as a hydrocele, varicocele, or even a soft tissue tumor could potentially present with a mass, but these are less likely to cause the acute, severe symptoms described. Additionally, conditions like meconium peritonitis or ovarian torsion in female infants, though rare, could present with abdominal or groin pain and a mass, but are less likely given the specific description provided.