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

• Single Most Likely Diagnosis
  • Inguinal Hernia (specifically, an incarcerated or strangulated hernia): The presence of a firm, hot, tender, and bluish inguinal mass in an infant, accompanied by continuous crying, suggests an incarcerated or strangulated hernia. This condition occurs when part of the intestine becomes trapped and is at risk of losing its blood supply, leading to tissue death. The normal appearance of the groin does not rule out this diagnosis since the hernia itself may not always be visible or reducible.
• Other Likely Diagnoses
  • Testicular Torsion: Although less common in infants, testicular torsion is a surgical emergency that can present with a firm, tender testicle and could potentially cause an inguinal mass if the torsion occurs at the level of the inguinal canal. The bluish discoloration could be due to compromised blood flow.
  • Appendageal Torsion (e.g., torsion of the appendix testis or appendix epididymis): This condition can mimic testicular torsion in its presentation and could potentially cause a tender inguinal mass, though it is less likely to cause a bluish discoloration.
• Do Not Miss Diagnoses
  • Testicular Torsion: As mentioned, this is a surgical emergency that requires prompt intervention to save the testicle. Missing this diagnosis could result in loss of the testicle and potential long-term fertility issues.
  • Strangulated Hernia: Similar to testicular torsion, a strangulated hernia is a surgical emergency. Failure to diagnose and treat promptly can lead to necrosis of the trapped intestine, peritonitis, and potentially life-threatening complications.
• Rare Diagnoses
  • Ectopic Testis with Torsion: An ectopic testis is a testis that is located in an abnormal position, and if it undergoes torsion, it could potentially present as an inguinal mass. However, this condition is rare and would be less likely than the other diagnoses listed.
  • Inguinal Canal or Scrotal Vascular Malformations: These could potentially cause a mass and discoloration but are less common and would typically have other distinguishing features or a different clinical history.