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Is the swelling there all the time? Or does it appear at certain times of the day.
Please enter chat and use reply to respond.
Alright, does it appear to bulge out when he is crying? or straining?
It would be helpful if you can send in a picture.
Alright, inguinal hernia is one possibility but there are others as well like a femoral hernia, which is also common in children of his age group.
Another possibility is of a saphenavarix.
Hernias are of all types. There are inguinal hernias - direct or indirect. Then there are femoral hernias, which appear almost at the inguinal crease towards the pubic bone.
Can you tell me if his scrotum seems developed and if you can feel his testis in the scrotum?
Okay, then I guess I am having a problem understanding where this is. Let me send you a picture of an anatomy slide and using your tablet you can mark the area where this is located.
Can you work on it?
Okay so much lower than where the inguinal hernia would be?
Okay! I think I understand where it is. And is this symmetrical on both sides?
Can you do this easily or is there resistance?
Can you straighten his legs without causing additional creases on the thighs?
Okay, then this is a soft tissue swelling.
Is it soft, firm or hard?
This does not sound like dysplasia.
Can you feel any borders of the swelling or does it appear to merge with the rest of the body.
I mean, does the swelling circumscribed - has borders which you can feel or is it diffuse? Am I making it harder? I am trying to figure out a way to get around the medical jargon, (there is no shortcut to a physical examination or seeing a picture)
*feel circumscribed with well defined borders?
Have you had him vaccinated recently, a few weeks back?
Okay, this is the area where there are inguinal or groin lymph nodes.
So, it could well be lymphadenitis.
The best way to reach a narrow differential will be an ultrasound.
It will rule out any swelling, soft tissue, hernia, lymph nodes.
That is the best course of action at this point in time i.e., if you can not get in to see his paediatrician.
I don't want to shoot arrows in the air and cause any anxiety since, I have not seen the swelling.
But it does not seem like hip dysplasia at all.
First of all, hip dysplasia would not present out of nowhere after 6 months. Secondly, with dysplasia the legs are of unequal lengths, there are asymmetrical creases on both sides and most of the times the crease in lower don on the thigh when you put the legs together, the knees don't match in length.
In children, the most common cause for lymphadenitis (swollen lymph nodes) is idiopathic - which literally means that they swell up without a cause.
Then another common cause is vaccines like Typhoid or the MMR.
Infections are also a cause but they present with fever as well, since there's no fever, infections are out of the list.
Lymph nodes without a cause, resolve on their own in a few months. Those with a cause need an evaluation and then the cause is treated and the lymph nodes get back to their size.
Sure, go ahead please.
Yes, it is under the inguinal crease and goes all the way around to the side of the upper thigh.
So, we have a few differentials here, in order of priority - swollen lymph nodes, lipoma, inguinal hernia, sphenavarix.
Well, you can actually. Take a photo and attach it to a photosite like photobucket.com or send me a link to your dropbox (if you use the app).
Yeah, but no one can trace an anonymous post back to you. You don't have to include your baby's face in the picture.
There is, you can send the picture to customer services telling them that you need to get it to me (Dr Uzair) and they will email the pictures to me, but that may take a few hours.
The last way is, that I can send you my email address, but the only way of doing that is that I send you my additional services request, if you accept it, then the site will allow me to post my email address to you.
Other wise, the site will block my email address and possibly my account for violating its policies.
It's requires an additional payment on your part. I can minimize the payment but if you accept it, the chat interface will convert in to a Q and A thread and you will be automatically paying me for the original question.
And since, we've gone this far, I can put the additional payment in cents for you.
You've offered to make a payment of US $ 16.78 for this question, if you accept the additional services offer, you will be accepting that you make that payment to me.
Nothing, you just need to say the word and I'll send the request which will appear on your screen.
Yes, part of that payment goes to me.
0.99 cents for the additional services, that is the only way I can send you my email address. But if you don't want that, then you can use any of the other methods we talked about.
I usually tell my patients and customers to post their pictures on photobucket if they can not attach them to this applet or thread.
That is the most convenient way.
Haha, okay. So, we can continue without the picture, I'm trying to make it easier for both of us, but it ended up getting more complicated.
We can start discussing the differentials.
Okay let me ask you some questions to rule out congenital or developmental hip dysplasia.
Do you hear a click or clunk when you squat or straighten his hips?
Towards the inside?
Vertically or diagonally?
Okay, let me simplify this (if I dare). If you notice no asymmetry in the gluteal folds, if there are no clicks or clunks on adducting and abducting his thighs, if there is no limb length inequality and if the paediatrician has examined him and did not mention congenital hip dysplasia (CHD), then this is definitely not CHD.
And, the head of the femur, dislocates to the outside, not the inside, so there is no fold on the upper inner thigh in a CHD patient.
Yes, it does, this is the gluteal crease, the baby is shown from behind, you said that the gluteal creases are equal in your boy's case.
Exactly, so they wouldn't be equal if he had hip dysplasia.
So, that confirms that he does not have hip dysplasia.
There are a lot of reasons for a swelling, as I made mention of a few in the start and one can not comment on what kind of swelling it might be without a physical examination.
Unlikely, that what your boy has is a major hip dysplasia.
The legs are equal in length, there are no clicks and clunks, he has had a physical examination by a paediatrician.
I doubt that the case here is a hip dysplasia.
If you are going to send a picture, send both, from the back and the front with the legs straight and the knees placed together.
Yes, I'm here.
Okay. Which one is you think is the most secure way?
Alright, I am going to send you the additional services request. Accept it, the chat will be converted to a q and a thread, we'l go back and forth on that.
The chat automatically converts.
Did you get the "offer"?
Okay, I sent it.
Check your email as well.
That is why the offer didn't go through.
Sure, send it to customer services.
Yes, usually does.
Okay, save the picture in your dropbox and send me the link here.
Yes, just simply take the picture out of the dropbox and it'll be gone
Yes, you can find it on the apple store and download it.
Takes a couple of minutes.
Sign in and simply save your picture in it.
then open the picture, click on the options/sharing icon and select copy link.
Then paste the link in this text box.
you can cancel that now or later, no one can see those pictures except you.
Just let it copy and then open the picture you want me to see and generate the link and paste it here.
Just copy the pictures from your photo gallery and paste them in the drop box.
Then generate the link and paste here.
No. The free works fine.
In your photo gallery, open the options for that picture and it will say share with or send to drop box
Where did the photos you took go?
Okay, open your drop box. There are three dots on the right upper corner.
Tap on that, it will open a pop up.
Click on photos
That will take you to your gallery.
And then you can select the photos you want to import to the drop box.
I am telling you how to get them there.
There are three dots on the upper right corner when you open the dropbox app.
"Add files?" option there.
Any where on the screen?
On the screen of your Ipad, does it say "files" anywhere?
Do you have your drop box open?
See if you can find an icon on the lower left corner that says files.
Tap on that.
No. Skip that.
Once, your on the files screen, tap the three dots icon.
Then add files.
Then try to set up like it wants you to.
Once, they are in, open the file/photo you want to show me.
There is an icon - an arrow coming out of a box, right next to the three dots when you open the picture. On the upper right corner.
Do you see it?
Okay, tap on that and then you will see a tab that says generate link
Or copy link, yes.
Yes, tap on that.
And it will generate a link
Paste it here.
Tap and hold on this text box for 3 secs and the option box should open.
Try the copy link again.
Okay tap and hold and then let go to get the options.
Did you try again - copy link and paste again.
Okay. I don't why that is happening. It should normally just give an option to paste after you have generated a link.
Yes! And then you should be able to paste it here.
Photobucket.com - create a log in there and send me the link of the picture. You can delete it thereafter if you are concerned about privacy issues.
You can try it, but I doubt it.
I've never tried that.
You tell me! :)
No, not really, we've exhausted all the options except the photobucket one.
Yes, probably is. Mac / iOS is not compatible with a lot things.
You go to the website. http://www.photobucket.com/
It says "upload" on the top left.
Click there. Sign in with your Facebook.
No, it is just going to use your facebook id to sign in to the website.
So, that you don't have to fill up their sign in form.
Sure, no problem. :)
Let me know when you're done.
Copy the link to that page where your photo shows and paste it here.
It should say link to share photos on the top right corner.
Yes! I thought you had done that.
It will give you options, the delete option should be on the lower right corner.
follow this link to get an idea.
Congratulations. This is not a hip dislocation.
Looks like a pad of fat at the minimum or a femoral hernia.
Could be any of the later two. An ultrasound will differentiate.
Yes, I can. It is a differential that comes to mind whenever there is a swelling under the inguinal crease on the medial side, similar to this one. No, it wouldn't show like that all the way up to the back, but there is nothing restricting it from going there either.
Lymph nodes do not extend all the way up to the inner thigh like this.
Yes, definitely a swelling (hernia is also a swelling).
It would expand with straining and when he is crying.
Okay, then really, you need to have this evaluated with an ultrasound. That is the first thing you're paediatrician is going to order.
If its a hernia a surgery will be required.
Not from the looks of it. Serious conditions are not so shy in their presentation. Bogy, red, swollen and painful.
I told you, either this is a pad of fat (lipoma) or a femoral hernia.
There is no cause, they just appear - the cause as they say is Idiopathic! Sometimes, they are genetic (Durcum's disease), but then they should be symmetrically on both sides and more than one. And the parents usually have them as well.
They just appear.
So, it can be a lipoma that just appeared without a cause.
Okay. Then more inclination towards this being a Lipoma.
Still one should keep it in the differentials list because one can not solely rely on the cough impulse or straining in femoral hernias.
No, it doesn't. You see, the legs are both equal, they are not tilted and this appears as a separate swelling then the gluteal crease, the real gluteal crease is present at its normal location in your boy, plus congenital hip dysplasias are present from birth and your paediatrician would have picked it up during the physical examinations. And there are no clicks and clunks there either.
If you're going to twist my arm hard enough, you might make me say this is a congenital hip dislocation, but its not.
Okay. Do you think you have my opinion?
Lipoma vs Femoral hernia.
Not complicated at all.
Recovery - as in when the stitches will be removed - in about 7 to 10 days.
No, I don't think you need to draw any conclusions before the paediatrician has seen him.
I can only draw an inference from what I can see and what you have told me. This does not look to be anything serious.
By serious I mean, something that would have a long lasting effect or something that can not be treated.
No! that is not what I said.
I said, a lipoma without a cause can be on any side - solitary
But those associated with a disease like Durcum's disease are on both sides. This is not durcum's disease.
It can be a lipoma on one side that just appeared without a cause.
I think we are taking too much time and going around in circles.
Lets just leave it at this: This does not look like a hip dislocation, it looks like a lipoma or a femoral hernia at the most.
Take him to see the Paediatrician and have an ultrasound done after the examination.
It was a pleasure.
Let me know if you have any future concerns and what your paediatrician says this is after the evaluation.
Your paediatrician will find out on the physical examination if this is a hip dislocation, if s/he is still unsure, an x ray will confirm.
Causes of femoral hernias need another hour or two to explain! Starting from the anatomy.
I did. But you seem to think it is.
I was answering that question: you will know when you're paediatrician will evaluate and confirm with an x ray.
I said it. But you don't believe me.
Okay. Thank you!
It doesn't look like a hip related issue.
Okay. But as a little favor, please do tell me what the Paediatrician labels this as.
I shall be available on the website, you can reply on this thread.
All the best and take care. And please do not be concerned about this.
For the last time? No, it doesn't. :)
Do leave a positive rating to compensate for my time and service. I shall be grateful.
You're most welcome.
Don't forget to follow up. Now I am as concerned as you are!
I do apologize, its only facts and science here. From the information and the pictures, it does not seem to be a hip problem - 95 percent - no hip.
Please leave a positive rating, I shall appreciate it.
They can be taken out.
You said last question.
No, they have to be taken out unfortunately.
Surgery or liposuction.
Yes. They can.
Might get bigger but not harmful.
Sometimes, they stay the same size as the baby grows.
Unpredictable like that.
No reason, as I said.
They are just clumps of fat.
All questions answered?
Because now I have to go to work as well.
Yes. They just appear.
Please leave a rating for me.
Yes, they are common in all age groups. No age restriction with lipomas.
They can appear at any age.
Its how and when you notice them.
Yes, that is a possibility.
But wouldn't want to say that over the internet without having examined him.
No, you should not be worried.
Please do leave a positive rating.