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Histories

Groin Swelling History | MRCS Part B OSCE Revision

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Clinical Scenario

A patient with a history of intravenous drug use is referred by his GP with a painful, swollen groin, initially thought to be an abscess. He has come in now because over the last two days the lump has rapidly got bigger, throbs constantly, is too painful to walk on, and he has started having fevers and shaking episodes.

Take a focused history from this patient.

Related Differentials · Same Topic
The examiner could set this station around a different diagnosis within the same presenting complaint. Know how each would change the history.
Differential What would point to it in the history Management in brief
Infected femoral pseudoaneurysm (this case)Femoral injecting or instrumentation, pulsatile and rapidly expanding, constant throbbing pain, fevers and rigors, overlying cellulitis, herald bleed, distal ischaemia or nerve compressionResuscitate, blood cultures and IV antibiotics, urgent duplex/CT angiogram, immediate vascular referral — never incise and drain. Surgical: proximal control, excision and debridement with arterial ligation ± delayed extra-anatomical vein bypass
Groin abscessNo pulsatility, fluctuant, may point to skin, no distal ischaemic signsConservative: antibiotics if cellulitic only. Surgical: incision and drainage — but only once duplex has excluded a pseudoaneurysm
Infected haematomaHistory of trauma or bleeding into the groin, non-pulsatileConservative: antibiotics, correct clotting, observe. Surgical: evacuation and washout if large, infected or compressive
Inguinal lymphadenopathyDiscrete firm/rubbery nodes, non-pulsatile, source of infection elsewhereConservative: treat the primary source; investigate for lymphoma or metastasis if persistent. Surgical: excision biopsy for diagnosis
True femoral artery aneurysmPulsatile but not usually infected/inflamed; may be bilateralConservative: surveillance if small and asymptomatic, risk-factor control. Surgical: repair with interposition graft if large, symptomatic, thrombosed or embolising
Femoral herniaBelow and lateral to the pubic tubercle, often irreducible, high risk of strangulation with vomiting and obstructionSurgical: always repair — urgently if strangulated (low, high or inguinal approach with mesh or suture repair)
Saphena varixSoft, compressible swelling at the saphenofemoral junction, disappears on lying flat, cough impulse and thrill, with varicose veinsConservative: reassurance, compression stockings. Surgical: treat the underlying venous incompetence — endovenous ablation or saphenofemoral ligation

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