Differential Diagnosis for Markedly Swollen, Tender, Hard Testicle Following Trauma
- Single Most Likely Diagnosis
- Testicular rupture: This is the most likely diagnosis given the history of trauma and the physical examination findings of a markedly swollen, tender, and hard testicle. The elevated WBC count may indicate an inflammatory response to the injury.
- Other Likely Diagnoses
- Epididymitis: Although less likely than testicular rupture in the context of trauma, epididymitis could present with similar symptoms, including swelling, tenderness, and an elevated WBC count. The differentiation would depend on further diagnostic evaluation.
- Hematocele: A collection of blood in the scrotum, which could occur after trauma, might present with swelling and hardness of the testicle. However, the tenderness and elevated WBC count might be less pronounced compared to testicular rupture.
- Do Not Miss Diagnoses
- Testicular torsion: Although the history of trauma might suggest a different primary diagnosis, testicular torsion is a medical emergency that can present with acute pain and swelling. It requires immediate intervention to save the testicle, making it a critical "do not miss" diagnosis.
- Necrotizing fasciitis: This is a rare but potentially deadly infection of the skin and subcutaneous tissues. Given the elevated WBC count and the potential for infection following trauma, it's essential to consider this diagnosis, especially if the patient shows signs of severe infection or sepsis.
- Rare Diagnoses
- Testicular cancer with traumatic rupture: Although testicular cancer itself is not rare, the combination of cancer and traumatic rupture is uncommon. However, any testicular mass or unusual findings on examination should prompt further investigation, including imaging and potentially biopsy.
- Spermatic cord injury: Direct injury to the spermatic cord can occur with trauma and might present with pain and swelling. However, this would be less likely to cause a markedly hard testicle compared to other diagnoses listed.