Differential Diagnosis for Testicular Pain

The patient presents with testicular pain, swelling, and exacerbation of pain with movement or coughing. Here's a categorized differential diagnosis:

• Single most likely diagnosis
  • Epididymitis: This is the most likely diagnosis given the patient's symptoms of testicular pain, swelling, and exacerbation of pain with movement or coughing. Epididymitis is an inflammation of the epididymis, usually caused by a bacterial infection, and is common in sexually active men. However, it can also occur in non-sexually active men due to other causes such as urinary tract infections.
• Other Likely diagnoses
  • Orchitis: Inflammation of one or both testicles, usually caused by viral or bacterial infections. The patient's symptoms of testicular pain and swelling could be consistent with orchitis.
  • Testicular torsion (early presentation): Although testicular torsion typically presents with sudden, severe pain, early presentations can be more subtle. The patient's delayed onset of pain and exacerbation with movement or coughing could be consistent with an early presentation of testicular torsion.
  • Hydrocele: A fluid-filled sac in the scrotum that can cause swelling and discomfort. While hydrocele is usually painless, it can cause discomfort or pain if it becomes large enough or if there is an associated infection.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
  • Testicular torsion: As mentioned earlier, testicular torsion is a surgical emergency that requires prompt attention. Delayed diagnosis can result in loss of the testicle and potential long-term fertility issues.
  • Testicular cancer: Although rare, testicular cancer can present with pain, swelling, or a palpable mass. It is essential to consider this diagnosis, especially if the patient has a history of testicular cancer or if the physical examination reveals a suspicious mass.
• Rare diagnoses
  • Spermatocele: A cystic structure filled with sperm that can cause swelling and discomfort in the scrotum. While usually painless, a spermatocele can become large enough to cause discomfort or pain.
  • Varicocele: A swelling of the veins in the scrotum that can cause discomfort or pain. Varicocele is usually a chronic condition, but it can cause acute pain if there is a sudden increase in size or if there is an associated thrombosis.
  • Henoch-Schönlein purpura (HSP): A systemic vasculitis that can cause testicular pain, swelling, and skin rash. HSP is rare in adults, but it can occur and should be considered in the differential diagnosis if there are other systemic symptoms or signs of vasculitis.