Differential Diagnosis for a 57 y/o Male with Intermittent Unilateral Groin and Lower Quadrant Abdominal Burning Pain

• Single Most Likely Diagnosis
  • Inguinal ligament strain or enthesopathy: The symptoms of intermittent unilateral groin pain, exacerbated by activities that increase intra-abdominal pressure (such as sneezing, exertion, defecation, Valsalva maneuver, and walking), are consistent with a strain or enthesopathy of the inguinal ligament. The absence of a hernia on CT scan supports this diagnosis, as ligament issues might not be visible.
• Other Likely Diagnoses
  • Osteitis pubis: This condition, characterized by inflammation of the pubic bone and its surrounding structures, can cause groin pain that radiates to the lower abdomen and is exacerbated by weight-bearing activities and Valsalva maneuvers.
  • Sports hernia (athletic pubalgia): Although the CT scan did not show a traditional hernia, sports hernias often do not have a visible bulge and can cause chronic groin pain, especially with activities that increase intra-abdominal pressure.
  • Referred pain from lumbar spine issues (e.g., lumbar disc disease): Pain from the lumbar spine can refer to the groin area and be exacerbated by activities that increase pressure on the spine, such as lifting, bending, or walking.
• Do Not Miss Diagnoses
  • Testicular torsion: Although less likely given the intermittent nature of the pain and the absence of acute severe pain, testicular torsion is a medical emergency that requires immediate attention. Any testicular pain should prompt a thorough evaluation.
  • Appendicitis or other intra-abdominal pathology: While the CT scan was negative, it's crucial to consider other intra-abdominal pathologies, especially if the pain pattern changes or worsens, indicating a possible missed diagnosis.
  • Vascular issues (e.g., aortic aneurysm, iliac artery aneurysm): These conditions can cause abdominal and groin pain, especially with exertion, and are critical to diagnose due to their potential for severe complications.
• Rare Diagnoses
  • Nerve entrapment syndromes (e.g., ilioinguinal neuralgia): These can cause burning pain in the groin area and are often exacerbated by activities that put pressure on the affected nerve.
  • Avulsion fractures or stress fractures of the pubic bone or surrounding areas: These could cause localized pain that might radiate to the groin and lower abdomen, especially with weight-bearing activities.
  • Inflammatory conditions (e.g., ankylosing spondylitis, reactive arthritis): These can cause a variety of symptoms including groin pain, especially if there's involvement of the sacroiliac joints or spine.