Differential Diagnosis for Testicular Ultrasound Findings
- Single most likely diagnosis:
- Epididymitis: The thickening of the right epididymis in the distal portion at the inferior pole of the testicle, combined with the presence of a large hydrocele, suggests an inflammatory process such as epididymitis. The normal color flow signal within the testicle and the absence of varicocele support this diagnosis.
- Other Likely diagnoses:
- Spermatocele: The thickening of the epididymis could also be due to a spermatocele, which is a cystic structure that contains sperm. However, the absence of a clear cystic structure on the ultrasound makes this diagnosis less likely.
- Epididymal cyst: Similar to a spermatocele, an epididymal cyst could cause thickening of the epididymis. However, the ultrasound findings do not specifically support this diagnosis.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
- Testicular torsion: Although the ultrasound shows normal color flow signal within the testicle, testicular torsion is a medical emergency that requires prompt attention. The presence of a large hydrocele could potentially mask the symptoms of testicular torsion.
- Testicular cancer: While the ultrasound shows a homogeneous parenchyma, testicular cancer is a possibility that should not be missed. The presence of a simple cyst in the left testicle is a new finding, and further evaluation may be necessary to rule out malignancy.
- Rare diagnoses:
- Epididymal tuberculosis: This is a rare condition that could cause thickening of the epididymis. However, the ultrasound findings do not specifically support this diagnosis, and it would require further evaluation and laboratory tests to confirm.
- Vasculitis: This is a rare condition that could affect the testicular arteries and cause changes in the resistive index (RI). However, the RI values in this case are within the normal range, making this diagnosis unlikely.