Differential Diagnosis for Testicular Pain

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

• Single Most Likely Diagnosis

  • Epididymitis: This is often the most common cause of testicular pain, especially in sexually active men. It is an inflammation of the epididymis, usually caused by bacterial infection, and presents with pain, swelling, and tenderness of the testicle.

• Other Likely Diagnoses

  • Orchitis: Inflammation of one or both testicles, usually caused by bacterial or viral infections. It can occur alone or in conjunction with epididymitis (epididymo-orchitis).
  • Testicular torsion (early stages): While it's a medical emergency, in its early stages, it might not present with the classic severe pain and can be mistaken for other conditions.
  • Varicocele: Enlargement of the veins within the scrotum, similar to varicose veins. It can cause a dull ache or discomfort and is more common on the left side.
  • Hydrocele: Accumulation of fluid around a testicle, causing swelling and discomfort.

• Do Not Miss Diagnoses

  • Testicular Torsion: A medical emergency that requires immediate attention. It involves the twisting of the spermatic cord, cutting off the blood supply to the testicle. Delayed treatment can result in loss of the testicle.
  • Testicular Cancer: Although less common, it's crucial to consider, especially in men with a history of undescended testes or family history of testicular cancer.
  • Appendix Testis Torsion (Hydatid of Morgagni): A small appendage to the testis that can twist and cause severe pain, often mimicking testicular torsion.

• Rare Diagnoses

  • Spermatocele: A cystic structure filled with sperm, usually painless but can cause discomfort if large.
  • Henoch-Schönlein Purpura (HSP): A form of vasculitis that can cause testicular pain among other symptoms like purpura, arthritis, and abdominal pain.
  • Polyarteritis Nodosa (PAN): A systemic vasculitis that can involve the testicular arteries, leading to pain and potentially more severe complications.
  • Fat Necrosis: Rare condition where fatty tissue in the scrotum becomes necrotic, leading to pain and swelling.

Each of these conditions has distinct characteristics and requires careful consideration based on the patient's presentation, history, and physical examination findings.