Differential Diagnosis for 25yo Male with Pelvic Pain and Testicular Pain
Single Most Likely Diagnosis
- Varicocele: This condition is characterized by an enlargement of the veins within the scrotum, similar to varicose veins. The pain often worsens throughout the day, especially when standing, and improves when lying down. The symptoms described match closely with varicocele, making it a prime candidate for the single most likely diagnosis.
Other Likely Diagnoses
- Epididymitis: Inflammation of the epididymis, a tube at the back of the testicle that stores and carries sperm, can cause pain that may worsen with standing due to increased pressure and movement. This condition is often associated with urinary tract infections or sexually transmitted infections.
- Orchitis: Inflammation of one or both testicles, usually caused by bacterial or viral infections, can lead to pain that may be exacerbated by movement or standing.
- Hydrocele: Accumulation of fluid around a testicle can cause discomfort or pain, which might be more noticeable when standing due to gravitational effects on the fluid.
Do Not Miss Diagnoses
- Testicular Torsion: Although less common, this is a medical emergency where the spermatic cord becomes twisted, cutting off the blood supply to the testicle. It can cause severe pain, often sudden in onset, and is not necessarily relieved by position change. Missing this diagnosis can lead to loss of the testicle.
- Appendicitis: While the primary symptom is usually abdominal pain, in some cases, especially if the appendix is located near the pelvic area (retrocecal appendix), the pain can be referred to the testicles or groin area. Appendicitis is a surgical emergency.
Rare Diagnoses
- Spermatocele: A cystic structure filled with sperm that arises from the head of the epididymis. It can cause a sensation of heaviness or pain, especially if large, but is less common and usually not as painful as other conditions listed.
- Testicular Cancer: Though rare in young men, testicular cancer can cause aching in the abdomen or groin, and a feeling of heaviness or discomfort in the testicle. It's essential to consider this in the differential diagnosis due to its potential severity and the importance of early detection.