Testicular Pain Differential Diagnoses
The following differential diagnoses for testicular pain are categorized based on their likelihood and potential impact on patient health.
Single Most Likely Diagnosis
- Epididymitis: This is an inflammation of the epididymis, usually caused by a bacterial infection. It's the most common cause of testicular pain in young men, especially those who are sexually active. The pain is often accompanied by swelling, redness, and warmth of the scrotum.
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): Although it's a medical emergency, in its early stages, testicular torsion might not present with the classic severe pain and can be mistaken for other conditions.
- Varicocele: An enlargement of the veins within the scrotum, similar to varicose veins. It can cause a dull, aching pain, especially later in the day.
- Hydrocele: A fluid-filled sac that can cause swelling of the testicle, leading to discomfort or pain.
Do Not Miss Diagnoses
- Testicular Torsion: A medical emergency where the spermatic cord becomes twisted, cutting off the blood supply to the testicle. It requires immediate surgical intervention to save the testicle.
- Testicular Cancer: Although less common, testicular cancer can present with a painless testicular mass, but sometimes it can cause pain, especially if there's bleeding into the tumor.
- Appendix Testis Torsion (Hydatid of Morgagni): A small appendage at the top of the testicle can twist, causing severe pain. It's more common in children and young adults.
Rare Diagnoses
- Spermatocele: A cystic structure filled with sperm that arises from the head of the epididymis. It usually doesn't cause pain unless it becomes large enough to exert pressure on surrounding structures.
- Cystic dysplasia of the testis: A rare congenital anomaly that can cause testicular enlargement and pain.
- Henoch-Schönlein Purpura (HSP): A form of vasculitis that can affect the testicles, among other areas, causing pain, swelling, and skin purpura.
- Fat necrosis of the epididymis: A rare condition where fatty tissue within the epididymis undergoes necrosis, leading to pain and swelling.