Differential Diagnosis for a Firm Lump at the Bottom of the Right Testicle
- Single most likely diagnosis
- Epididymal cyst: This is the most likely diagnosis given the description of a firm, mobile lump at the bottom of the testicle with minimal tenderness. Epididymal cysts are common and usually benign, presenting as a palpable mass that can be transilluminated.
- Other Likely diagnoses
- Spermatocele: A spermatocele is a cystic structure that forms at the head of the epididymis and can present similarly to an epididymal cyst. It is also usually benign and may contain sperm.
- Hydrocele: Although a hydrocele typically presents as a swelling of the entire scrotum, a small hydrocele could potentially be mistaken for a lump at the bottom of the testicle. It is characterized by the accumulation of fluid around a testicle.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Testicular cancer: While less common, testicular cancer is a critical diagnosis not to miss. It can present as a firm, painless lump in the testicle. Given the potential for serious outcomes if not treated promptly, it is essential to consider this in the differential diagnosis.
- Epididymitis or orchitis: Inflammation of the epididymis (epididymitis) or testis (orchitis) can cause a lump and tenderness. Although the patient reports minimal tenderness, these conditions can have varying presentations and are important to rule out due to their potential for complications.
- Rare diagnoses
- Adenomatoid tumor: A rare, benign tumor of the epididymis or testicle that can present as a firm lump.
- Lipoma of the spermatic cord: A benign tumor composed of fat tissue that can occur in the spermatic cord and present as a lump near the testicle.
- Varicocele: An enlargement of the veins within the scrotum, which can feel like a lump or swelling, typically on the left side but can occur on the right. It's more common in younger men and associated with a "bag of worms" sensation.