A 40-year-old woman has a soft, bluish, compressible swelling just below and lateral to the pubic tubercle at the groin crease. It transmits a cough impulse and completely disappears when she lies flat with the leg elevated. Which is the correct diagnosis and its key distinguishing feature?
- A Femoral hernia; it is irreducible and lies lateral to the pubic tubercle
- B Saphena varix; it empties on elevating the leg and refills on standing with a fluid thrill on coughing ✓
- C Psoas abscess; it is associated with flexion deformity of the hip
- D Enlarged Cloquet node; it is firm and fixed deep to the fascia lata
Correct answer: B. Saphena varix; it empties on elevating the leg and refills on standing with a fluid thrill on coughing
Explanation
A saphena varix is a dilatation of the terminal great saphenous vein at the saphenofemoral junction and classically mimics a femoral hernia. The discriminating sign is that it empties completely on lying flat with leg elevation and refills instantly on standing, with a palpable fluid thrill on coughing due to the venous column; a femoral hernia never empties on elevation. Both lie below the inguinal ligament near the pubic tubercle, so location alone does not separate them.
Reference: Bailey and Love's Short Practice of Surgery, 28th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.