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What is the hard lump on my 4 year old son's front groin area?

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I just noticed that my 4yr old son (42inches tall/lean) has a hard lump in his front groin area. I pushed on it and asked him if it hurt he said no, but when I did I could tell by the look on his face that he felt something. The lump is hard and slighlty bluish. When he pushed his pelvis/belly forward and leans back slightly, the lump protrudes and is more noticable. He does have a hernia above his belly button that he's had since birth.
Posted Tue, 17 Apr 2012 in Child Health
Answered by Dr. Rakhi Tayal 17 minutes later
Thanks for writing to us.
Depending on exact location a painful groin lump could be any of three general possibilities.
The first consideration is - lymph node. There is a cluster of lymph nodes in the groin which can become inflamed in response to some kind of infection. If you have any symptoms of infection in general including fever, pain with urination, or infection of toes or nails, this could trigger lymph node swelling.
Since this is a good possibility we also need to know the size, number of lymph nodes along with its texture. We also need to check if it is on both sides. A lot of causes can be ruled out by physical examination of these lymph nodes.
Lymphadenopathy (swollen lymph nodes) is usually caused by a viral or bacterial infection. Other causes include allergic reactions or some malignancy.
For this, a FNAB (fine needle aspiration biopsy) of the lymph nodes and swollen glands is the best test. FNAB is aspiration of the material of the glands which is done by a fine gauge needle (22 or 25 gauge) and a syringe. This will confirm the diagnosis.
The second possibility is that this could be a small infected sebaceous cyst. This is triggered by an ingrown hair which causes an infection and the infection progresses somewhat until pus accumulates under the skin. These can be quite painful and sometimes are treated with antibiotics or even a small procedure where the cyst is drained surgically.

The last possibility would be a hernia. These tend to be larger and are caused by a small weakness in the abdominal wall which allows for part of the bowels to push through creating a palpable lump.
Please visit your pediatrician to undergo physical check up and also to undergo relevant investigations required in your case.
Hope this answers your query. If you have additional questions or follow up queries then please do not hesitate in writing to us. I will be happy to answer your queries.
Wishing you good health.

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