Importance of lipoma of the cord

This may be a silly question then, but if a fat-containing hernia and cord lipoma look the same on ultrasound, can anyone tell them apart before surgery? Do they differentiate clearly in MRI or CT imagery?

Can a cord lipoma be asymptomatic and a random finding, whereas a hernia is maybe more likely to cause sudden pain onset or general aggravation? Or are they both possible to be causing inguinal symptoms in a patient?