Differential Diagnosis for a 37-year-old Patient with Right Testicular Pain and Swelling

Given the symptoms of right testicular pain and swelling, along with a positive urinalysis (UTI), the differential diagnosis can be categorized as follows:

• 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 often associated with UTIs, especially in sexually active men. The symptoms of epididymitis, such as testicular pain and swelling, match the patient's presentation, and the positive UTI supports this diagnosis.

• Other Likely Diagnoses

  • Orchitis: Inflammation of one or both testicles, usually caused by bacterial or viral infections. Given the patient's symptoms and positive UTI, orchitis is a plausible diagnosis, especially if the infection has spread from the epididymis to the testicle.
  • Testicular Torsion: Although less likely given the presence of a UTI, testicular torsion is a condition where the spermatic cord becomes twisted, cutting off the blood supply to the testicle. It typically presents with sudden, severe testicular pain and can occur at any age. The presence of swelling could be consistent with this diagnosis, but the positive UTI makes it less likely.

• Do Not Miss Diagnoses

  • Testicular Torsion: Despite being mentioned under other likely diagnoses, testicular torsion is a "do not miss" diagnosis due to its potential for severe and permanent damage if not treated promptly. The key distinguishing feature from epididymitis or orchitis is the sudden onset of severe pain, but the presence of a UTI might obscure this typical presentation.
  • Testicular Cancer: Although rare and less likely to present with acute pain and swelling, testicular cancer can cause a mass that might be painful, especially if it undergoes hemorrhage or torsion. Given the age of the patient, this diagnosis should not be overlooked, even though the acute presentation and positive UTI make it less probable.

• Rare Diagnoses

  • Henoch-Schönlein Purpura (HSP): A form of vasculitis that can affect various parts of the body, including the testicles, leading to pain and swelling. It's more common in children but can occur in adults. The presence of a UTI and the specific symptoms might make this diagnosis less likely, but it remains a rare consideration.
  • Spermatocele or Epididymal Cyst: These are benign conditions that can cause testicular swelling but are less likely to cause acute pain unless they become infected or rupture. They are not directly related to a UTI but could be considered in the differential diagnosis for testicular swelling.