Groin Lumps: Causes, Treatments, and When to Seek Surgery

There is a lump in the groin area?

I have had a hard lump in my groin for three months.
It started suddenly with a hard lump on the left side of my groin, which swelled up and caused pain while walking.
A surgeon diagnosed it and to find the cause, I underwent an ultrasound, blood tests (showing elevated white blood cell count), and a CT scan (approximately 4x3 cm).
There were no aspirations or biopsies performed.
I took antibiotics (Zyvox, linezolid 600 mg) twice daily for one to two weeks, which reduced the swelling, but a small hard lump remained.
The doctor mentioned that it could either resolve naturally or be surgically removed, and I was not prescribed any further antibiotics.

After another week or two, the lump swelled again, and there was a pus-filled abscess (approximately 4x3 cm).
I went to the emergency department where a small incision was made to drain the pus, which was later tested and found to contain Enterococcus gallinarum.
The abscess wound has been discharging fluid, and I have been applying Fucidin cream and changing the dressing daily.
Other areas have also developed several openings that are getting larger.
I return for follow-ups every two weeks, continuing to take antibiotics.
Currently, the openings show signs of drying up, and the discharge is decreasing.
The hard lump beneath the abscess has shrunk and feels less prominent, but there is still a noticeable hard lump about 2x1 cm beneath the abscess, which is somewhat firm and slightly painful.
I would like to inquire whether the cause of such a large hard lump is a bacterial infection.
Given the duration of the condition without resolution, what might be the reason? Should I continue taking antibiotics until the hard lump completely resolves, or would you recommend surgical removal? Thank you.

Wuming, 20~29 year old female. Ask Date: 2016/05/19

Dr. Chen Sirong reply Oncology

Anonymous / 27 years old / Male
1.
There has been a hard lump in the groin for three months.

2.
The surgical diagnosis included ultrasound, blood tests (elevated white blood cell count), and a CT scan (approximately 4x3 cm), but no aspiration or biopsy was performed.

3.
After taking antibiotics (Zyvox, linezolid 600 mg) twice daily for two weeks, the abscess resolved, but there is still a hard lump approximately 2x1 cm beneath it.

Is the hard lump caused by a bacterial infection? Given the duration, what could be the reason?
ANS: The possible causes could be:
1.
Bacterial infection leading to lymphadenopathy.

2.
Benign tumor with a bacterial infection.

3.
Malignant tumor with a bacterial infection.

Should I continue taking antibiotics until the hard lump completely resolves, or is surgery recommended to remove it? Thank you.

ANS: Surgical excision would provide a pathological examination report to determine the nature of the lump, although there may be uncertainties.

Taoyuan Hospital, Dr.
Chen Sih-Rong.

Reply Date: 2016/05/19

More Info

When dealing with groin lumps, particularly in your case where there has been a significant history of infection and the presence of a hard lump, it is essential to understand the potential causes, treatment options, and when surgical intervention may be necessary.

Causes of Groin Lumps
Groin lumps can arise from various conditions, including:
1. Infections: Bacterial infections, such as those caused by Enterococcus gallinarum (as in your case), can lead to abscess formation. This is characterized by a collection of pus that can cause swelling and pain.

2. Lymphadenopathy: Enlarged lymph nodes due to infections, inflammation, or malignancy can present as lumps in the groin area.

3. Hernias: An inguinal hernia occurs when tissue protrudes through a weak spot in the abdominal muscles, which can sometimes feel like a lump.

4. Cysts: Sebaceous cysts or other types of cysts can form in the groin area.

5. Tumors: Both benign and malignant tumors can present as lumps.

Treatment Options
In your situation, the initial treatment with antibiotics (Zyvox, linezolid) was appropriate for managing the bacterial infection. The fact that the lump initially decreased in size indicates a positive response to the antibiotics. However, the recurrence of the lump and the formation of an abscess suggest that the infection may not have been entirely resolved, or there may be an underlying issue that needs to be addressed.

1. Antibiotics: Continuing antibiotics is crucial, especially if there is ongoing infection. It is essential to complete the prescribed course and follow up with your healthcare provider to monitor progress.

2. Drainage: The emergency procedure to drain the abscess was necessary to relieve pressure and remove pus. This is often a critical step in treating an abscess.

3. Wound Care: Proper wound care, including the use of topical antibiotics like Fucidin cream, is important to prevent further infection and promote healing.

4. Observation: If the lump is decreasing in size and the discharge is lessening, it may be appropriate to continue monitoring the situation. Regular follow-ups with your healthcare provider are essential to ensure that the infection is resolving.

When to Consider Surgery
Surgical intervention may be warranted in the following scenarios:
1. Persistent or Recurrent Abscess: If the lump does not continue to decrease in size or if it re-accumulates fluid, surgical drainage or excision may be necessary.

2. Underlying Conditions: If imaging studies or further evaluations suggest an underlying condition (such as a tumor or hernia), surgery may be required to address the root cause.

3. Pain and Discomfort: If the lump continues to cause significant pain or discomfort, surgical removal may be considered to alleviate symptoms.

4. Failure of Conservative Treatment: If antibiotics and drainage do not lead to improvement, surgical options should be discussed.

Prognosis and Follow-Up
The prognosis for groin lumps largely depends on the underlying cause. In cases of bacterial infections, with appropriate treatment, many patients experience resolution. However, it is crucial to remain vigilant for any signs of complications, such as fever, increased pain, or spreading redness.

In summary, while your current treatment plan seems appropriate, it is essential to maintain open communication with your healthcare provider. Regular follow-ups will help determine whether the lump is resolving or if further intervention is necessary. If you have concerns about the lump's persistence or any new symptoms, do not hesitate to seek further medical advice.

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