Differential Diagnosis for Lesion on Outer Labia
- Single most likely diagnosis
- Bartholin's gland abscess or cyst with fistula formation: The initial drainage of clear/bloody fluid and subsequent hematoma formation, followed by refilling with blood, suggests a complex cystic structure that may have formed a fistulous tract. The hard tract into the groin supports this diagnosis, as it could represent a fistula.
- Other Likely diagnoses
- Infected sebaceous cyst or epidermoid cyst: Although there are no infective symptoms, an infected cyst could present with drainage and subsequent hematoma formation. The lack of infectious symptoms does not entirely rule out this possibility.
- Vulvar hematoma with pseudoaneurysm formation: The refilling with blood after hematoma formation could suggest a vascular anomaly such as a pseudoaneurysm, especially if there was significant trauma to the area.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Malignancy (e.g., vulvar cancer, adenocarcinoma of Bartholin's gland): Although less likely, any persistent or recurrent lesion, especially with unusual characteristics like a hard tract into the groin, warrants consideration of malignancy to ensure timely diagnosis and treatment.
- Necrotizing fasciitis or other severe soft tissue infections: The absence of infective symptoms does not rule out severe infections, especially in immunocompromised patients. These conditions are medical emergencies.
- Rare diagnoses
- Vulvar endometriosis: This condition can cause cystic lesions that may bleed, especially if they are connected to the menstrual cycle. However, it's less common and typically associated with pelvic endometriosis.
- Vascular malformations (e.g., arteriovenous malformation): These could present with a complex lesion and hematoma formation due to abnormal blood vessel structure. They are rare and might require specialized imaging for diagnosis.