Inguinal hernia sectional imaging with CT or MRI, the major differential in diagnosing indirect inguinal hernias is differentiation from spermatic cord lipomas, as both can contain only fat and extend along the inguinal canal into the scrotum. On axial CT, lipomas originate posterolateral to the cord, and are located inside the cremaster muscle, while inguinal hernias lie anteromedial to the cord and are not intramuscular. Large lipomas may appear nearly indistinguishable as the fat engulfs anatomic boundaries, but they do not change position with coughing or straining. Differential diagnosis of the symptoms of inguinal hernia mainly includes the following potential conditions: There
Superficial epigastric artery Superficial epigastric artery The superficial epigastric artery (not to be confused with the superior epigastric artery) arises from the front of the femoral artery about 1 cm below the inguinal ligament, and, passing through the femoral sheath and the fascia cribrosa, turns upward in front of the inguinal ligament, and ascends between the two layers of the superficial fascia of the abdominal wall nearly as far as the umbilicus. It distributes branches to the superficial subinguinal lymph glands, the superficial fascia, and the integument; it anastomoses with branches of the inferior epigastric, and with its fellow of the opposite side.