A 55-year-old woman has a soft bluish swelling in the right groin below the inguinal ligament. It disappears on lying down, has a fluid thrill, and there are obvious varicose veins in the same leg. Which feature best distinguishes this lesion from a femoral hernia?

• A Presence of a cough impulse
• B Position below and lateral to the pubic tubercle
• C Fluid thrill and disappearance on lying flat, with associated varicose veins, indicating saphena varix ✓
• D Irreducibility and tenderness

Explanation

A saphena varix is a dilatation of the termination of the great saphenous vein at the saphenous opening. It mimics a femoral hernia but gives a fluid thrill, has a bluish discoloration, vanishes promptly on lying down, and is accompanied by other varicose veins, reflecting its venous origin. Both lesions sit below the inguinal ligament near the pubic tubercle and both can show a cough impulse, so position and impulse do not discriminate. Irreducibility and tenderness would actually favour a complicated hernia.

Reference: Bailey and Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.