Differential Diagnosis for Testicle Pain when Laying Down

• Single Most Likely Diagnosis
  • Varicocele: This condition, characterized by an enlargement of the veins within the scrotum, can cause a dull ache or discomfort in the testicles, which may worsen when laying down due to increased venous pressure.
• Other Likely Diagnoses
  • Epididymitis: Inflammation of the epididymis, often due to infection, can cause testicular pain that may be exacerbated by position changes, including laying down.
  • Hydrocele: Accumulation of fluid around a testicle can lead to discomfort or pain, especially when in a supine position, due to the increased pressure on the testicle.
  • Spermatocele: A cystic structure filled with sperm that arises from the head of the epididymis can cause testicular pain, potentially worsening with certain positions.
• Do Not Miss Diagnoses
  • Testicular Torsion: Although less common, this is a medical emergency where the spermatic cord becomes twisted, cutting off the blood supply to the testicle. It can present with sudden, severe pain, which might not necessarily be position-dependent but should always be considered in cases of acute testicular pain.
  • Appendix Testis Torsion (Hydatid of Morgagni): Similar to testicular torsion, this involves the twisting of the appendix testis, a small appendage attached to the testis, and can cause severe pain.
• Rare Diagnoses
  • Testicular Cancer: While testicular cancer can cause aching or discomfort, it is less likely to be position-dependent. However, any persistent or unexplained testicular pain warrants further investigation.
  • Henoch-Schönlein Purpura (HSP): A form of vasculitis that can affect the testicles and cause pain, though this would typically be accompanied by other systemic symptoms such as rash, joint pain, and gastrointestinal symptoms.