Differential Diagnosis for Right Testicular Pain

The following is a differential diagnosis for right testicular pain, categorized for clarity and emphasis on critical conditions.

• Single Most Likely Diagnosis

  • Epididymitis: This is an inflammation of the epididymis, a tube at the back of the testicle that stores and carries sperm. It's often caused by a bacterial infection and is a common cause of testicular pain, especially in young men. The pain can be severe and is typically accompanied by swelling and redness of the scrotum.

• Other Likely Diagnoses

  • Orchitis: Inflammation of one or both testicles, usually caused by bacterial or viral infections. It can cause pain, swelling, and tenderness in the testicles.
  • Testicular Torsion: A condition where the spermatic cord (which contains the vas deferens, blood vessels, and nerves) becomes twisted, cutting off the blood supply to the testicle. It's less common than epididymitis but is a medical emergency.
  • Varicocele: An enlargement of the veins within the scrotum, similar to varicose veins. It can cause a dull ache or feeling of heaviness in the testicle and is more common on the left side but can occur on the right.

• Do Not Miss Diagnoses

  • Testicular Torsion: Although mentioned earlier, it's crucial to reiterate due to its emergency nature. Delayed treatment can result in the loss of the testicle.
  • Testicular Cancer: While less common, testicular cancer can present with pain, though it's often painless. It's critical to examine and potentially ultrasound the testicles to rule out cancer.
  • Appendicitis (with a retrocecal appendix): In rare cases, an inflamed appendix located behind the cecum can irritate the testicle and cause referred pain.

• Rare Diagnoses

  • Henoch-Schönlein Purpura (HSP): A form of vasculitis that affects blood vessels and can cause testicular pain among other symptoms like rash and joint pain.
  • Spermatocele: A cystic structure filled with sperm that arises from the head of the epididymis. It can cause a sensation of heaviness or dragging but is usually painless.
  • Idiopathic Scrotal Edema: A condition characterized by the sudden onset of scrotal swelling and redness without an identifiable cause, often seen in young boys.

Each of these conditions has distinct characteristics, but some can present similarly, making a thorough medical evaluation crucial for an accurate diagnosis and appropriate treatment.