Differential Diagnosis for Testicular Pain in a Child

Single Most Likely Diagnosis

• Epididymitis: This is the most common cause of testicular pain in children, often resulting from a bacterial infection, typically affecting the epididymis, which is the tube at the back of the testicle that stores and carries sperm.

Other Likely Diagnoses

• Testicular torsion: Although less common than epididymitis, testicular torsion is a significant cause of acute testicular pain and requires urgent medical attention to preserve the testicle.
• Orchitis: Inflammation of one or both testicles, usually caused by bacterial or viral infections, can lead to testicular pain.
• Varicocele: An enlargement of the veins within the scrotum, similar to varicose veins, can cause aching or discomfort in the testicle.

Do Not Miss Diagnoses

• Testicular torsion: As mentioned, this is a medical emergency that requires immediate attention. Delay in diagnosis can lead to loss of the testicle.
• Appendicitis: Although abdominal pain is the primary symptom, in some cases, especially if the appendix is located near the testicles (retrocecal appendix), the pain can radiate to the testicles.
• Inguinal hernia: An inguinal hernia can cause pain in the groin area that may radiate to the testicle, especially if the hernia becomes incarcerated or strangulated.

Rare Diagnoses

• Henoch-Schönlein purpura (HSP): A form of vasculitis that can cause testicular pain among other symptoms like purpura, joint pain, and gastrointestinal symptoms.
• Testicular cancer: Although rare in children, testicular cancer can present with a painless testicular mass, but sometimes it can cause pain, especially if there is bleeding or if the tumor has grown large enough to cause discomfort.
• Spermatocele or epididymal cyst: These are benign cysts that can cause discomfort or pain in the testicle, especially if they become large or infected.