Differential Diagnosis for a 51-year-old Male with a Tender Lump near the Left Pubic Tubercle
- Single most likely diagnosis:
- Inguinal ligament strain or enthesopathy: This condition is likely given the location of the pain (towards the left pubic tubercle area) and the fact that it's mostly palpable when standing, suggesting a mechanical or strain-related issue.
- Other Likely diagnoses:
- Osteitis pubis: Inflammation of the pubic bone and its surrounding structures, which could cause tenderness in the area, especially if the patient has a history of athletic activity or trauma.
- Pubic bone stress fracture: A possible cause, especially if the patient has been engaging in repetitive stress activities or has osteoporosis, though less common in men without specific risk factors.
- Soft tissue tumor (e.g., lipoma, cyst): Although less likely, a soft tissue tumor could present as a palpable lump in this area, especially if it's growing and causing discomfort.
- Do Not Miss diagnoses:
- Testicular cancer with metastasis to the pubic area: Although rare, testicular cancer can metastasize to unusual locations, including the pubic bone or surrounding soft tissues, making it crucial not to miss this potentially life-threatening condition.
- Osteomyelitis of the pubic bone: An infection of the bone that could present with localized pain and swelling, which is critical to diagnose and treat promptly to avoid serious complications.
- Metastatic disease to the pubic bone: Various cancers can metastasize to the bones, including the pubic bone, and present with pain and a palpable mass, making this a critical diagnosis not to overlook.
- Rare diagnoses:
- Bursitis of the iliopectineal bursa: Although bursitis can occur in various locations, inflammation of the iliopectineal bursa is less common and could potentially cause pain and swelling in the area near the pubic tubercle.
- Avulsion fracture of the pubic bone: Typically associated with significant trauma, an avulsion fracture could present with acute pain and a palpable defect in the bone, though this would be less common in the absence of a reported traumatic event.