Differential Diagnosis for Athlete with Groin Pain and Swelling

Single Most Likely Diagnosis

• Indirect Inguinal Hernia: This is a common condition in athletes, especially those involved in sports that require sudden stops, changes of direction, and rapid acceleration, which can increase intra-abdominal pressure and cause herniation through a weak point in the abdominal wall.

Other Likely Diagnoses

• Inguinal Hernia: Similar to indirect inguinal hernia, any type of inguinal hernia could cause groin pain and swelling, especially if it becomes incarcerated or strangulated.
• Rupture of the Inferior Epigastric Artery (IEA): Although less common, a rupture of the IEA can cause sudden onset of groin pain and swelling due to hematoma formation.
• Inguinal Hematoma: Trauma to the inguinal region can result in hematoma formation, leading to pain and swelling.

Do Not Miss Diagnoses

• Testicular Torsion: Although the primary symptom is testicular pain, it can sometimes be referred to the groin area. This condition is a surgical emergency and must be promptly diagnosed and treated to save the affected testicle.
• Epididymitis or Orchitis: Inflammation of the epididymis or testis can cause severe pain and swelling in the groin area and must be treated promptly to prevent complications.

Rare Diagnoses

• Sportsman's Hernia (Gilmore's Groin): A condition characterized by a chronic groin pain due to a weakness in the posterior wall of the inguinal canal, without a palpable hernia.
• Osteitis Pubis: An inflammatory condition of the pubic bone and surrounding structures, which can cause chronic groin pain, especially in athletes involved in sports that involve kicking or rapid changes of direction.

Each of these diagnoses has a different approach to management and treatment, ranging from surgical intervention for hernias and testicular torsion to conservative management for conditions like osteitis pubis. Accurate diagnosis is crucial for appropriate treatment and to prevent long-term complications.