Differential Diagnosis for a 17-year-old boy with a swollen, tender, and high-riding right testis
- Single most likely diagnosis
- Testicular torsion: This condition is characterized by the twisting of the spermatic cord, cutting off the blood supply to the testis. The symptoms described, including a high-riding testis with abnormal transverse lie and loss of cremasteric reflex, are classic for testicular torsion. Prompt diagnosis and treatment are essential to preserve testicular function.
- Other Likely diagnoses
- Epididymitis: Inflammation of the epididymis, usually due to bacterial infection, can cause testicular pain, swelling, and tenderness. However, the presence of a high-riding testis and loss of cremasteric reflex makes epididymitis less likely.
- Testicular trauma: Direct injury to the testis can cause swelling, pain, and tenderness. The history and physical examination would help differentiate trauma from other conditions.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Testicular tumor with torsion: Although rare, a testicular tumor can undergo torsion, presenting with similar symptoms. Missing this diagnosis could delay treatment of the underlying cancer.
- Appendicular torsion: Torsion of the appendix testis, a small appendage attached to the testis, can mimic testicular torsion. While not life-threatening, it can cause significant pain and should be considered in the differential diagnosis.
- Rare diagnoses
- Henoch-Schönlein purpura (HSP): A systemic vasculitis that can cause testicular pain and swelling, although this is a rare manifestation of the disease.
- Polyarteritis nodosa (PAN): A systemic vasculitis that can affect the testicular arteries, leading to ischemia and pain. However, this is an extremely rare cause of testicular symptoms in a young male.