Differential Diagnosis for Full Ache, Painful to Palpation Right Testicle

Single Most Likely Diagnosis

• Epididymitis: This condition, which is an inflammation of the epididymis (a tube at the back of the testicle that stores and carries sperm), is a common cause of testicular pain, especially in young men. It often presents with pain that may radiate to the lower abdomen, and the testicle may be swollen or tender to the touch. The absence of discharge or dysuria (painful urination) does not rule out epididymitis, as these symptoms can vary.

Other Likely Diagnoses

• Orchitis: Inflammation of one or both testicles, usually caused by bacterial or viral infections. It can present with testicular pain, swelling, and may be accompanied by symptoms like fever.
• Testicular Torsion: Although less common, this is a significant consideration because it is a surgical emergency. It occurs when the spermatic cord (which contains the vas deferens, blood vessels, and nerves) becomes twisted, cutting off the blood supply to the testicle. Pain can be severe and sudden.
• 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: As mentioned, this condition requires immediate medical attention to save the affected testicle. Delay in diagnosis can lead to loss of the testicle.
• Testicular Cancer: Although less common, testicular cancer can present with a painless testicular mass, but some patients may experience pain or discomfort. Given the potential severity of the outcome, it's crucial not to miss this diagnosis.
• Appendicitis (with an atypical presentation): In rare cases, appendicitis can present with testicular pain if the inflamed appendix is located near the testicle, causing referred pain.

Rare Diagnoses

• Spermatocele: A cystic structure that forms at the head of the epididymis and contains sperm. It's usually painless but can cause discomfort or pain in some cases.
• Henoch-Schönlein Purpura (HSP): A form of vasculitis that affects blood vessels and can cause testicular pain among other symptoms like purpura (rash), joint pain, and gastrointestinal symptoms.
• Fat Necrosis: A rare condition where fatty tissue in the scrotum becomes damaged, leading to inflammation and pain.

Each of these diagnoses has distinct characteristics, but the clinical presentation can sometimes overlap, making a thorough medical history, physical examination, and possibly diagnostic imaging necessary for an accurate diagnosis.