Differential Diagnosis for Right Achy Testicle with Small Epididymal Cyst on US
- Single most likely diagnosis:
- Epididymitis: This is the most likely diagnosis given the presence of a small epididymal cyst and mild, ongoing testicular ache. Epididymitis can cause chronic or recurrent pain and may be associated with epididymal cysts.
- Other Likely diagnoses:
- Testicular torsion (partial or intermittent): Although the patient's symptoms are mild and ongoing, partial or intermittent testicular torsion could cause intermittent pain and might not always present with the classic acute severe pain.
- Varicocele: A varicocele could cause a dull ache in the testicle and might be associated with an epididymal cyst, although this is less common.
- Hydrocele: A hydrocele could cause discomfort or a feeling of heaviness in the testicle, and while it's not directly related to an epididymal cyst, it's a common condition that could coexist.
- Do Not Miss diagnoses:
- Testicular cancer: Although testicular cancer is less common, it's crucial to consider it in the differential diagnosis, especially if there's a palpable mass or significant testicular asymmetry. The presence of an epididymal cyst does not rule out testicular cancer.
- Acute epididymitis (bacterial or viral): While the patient's symptoms are mild and ongoing, it's essential to consider acute epididymitis, especially if there are signs of infection or systemic symptoms.
- Rare diagnoses:
- Spermatocele: A spermatocele is a cystic structure filled with sperm, which could cause testicular discomfort or pain, although it's less common than an epididymal cyst.
- Adrenal rest tumors: These rare tumors can cause testicular pain and might be associated with other systemic symptoms, although they are uncommon.
- Polyarteritis nodosa (PAN) or other vasculitides: These conditions can cause testicular pain due to inflammation of the blood vessels and are essential to consider, although they are rare.