Node of the Groin (Differential Diagnosis as before)

swel_19a_n.jpg: Female toddler with a swelling of the right groin. The swelling has an oval shape which follows the longitudinal direction of the groin and protrudes spherically. The overlying skin is reddened. An incarcerated inguinal hernia or an acute lymphadenitis may be considered. swel_19b_n.jpg: Following skin incision a large amount of pus flows out; the clinically suspected diagnosis of an acute lymphadenitis with abscess is confirmed. The following clinical findings do not support an incarcerated inguinal hernia: The swelling concerns only the lateral two thirds of the inguinal fold; the medial third is free in the direction of the labium majus, just like the groin of the left side; the skin over the swelling is thin; notice the fine skin folds following abscess incision; a fluctuation of the swelling is palpable. In case of missing skin involvement a lymphadenitis may be mixed up with an inguinal hernia mainly in girls with frequent ovarian prolapse (I owe these pictures to K. Roth, Pediatric Surgery, CH-Aarau and Baden).