Differential Diagnosis for Sudden Left Groin Pain
Single Most Likely Diagnosis
- Epididymitis: The patient's presentation of sudden groin pain, elevated WBC and neutrophils, suggests an infectious or inflammatory process. Epididymitis, an inflammation of the epididymis, is a common cause of acute groin pain in young men and can be due to bacterial or viral infections.
Other Likely Diagnoses
- Orchitis: Inflammation of one or both testicles, often due to viral or bacterial infections, which can present with groin pain and elevated inflammatory markers.
- Testicular torsion (early stages): Although testicular torsion typically presents with severe pain and a palpable mass, early stages might not have a noticeable lump, and the elevated WBC and neutrophils could be seen in response to the ischemia.
- Inguinal hernia (incarcerated or strangulated): While the patient reports no lump, an incarcerated or strangulated hernia could potentially cause severe groin pain and elevated inflammatory markers without a palpable mass if it's not significantly protruding.
Do Not Miss Diagnoses
- Testicular torsion: This is a surgical emergency. Even though it might seem less likely given the absence of a lump, missing this diagnosis can result in loss of the testicle and potential long-term fertility issues.
- Appendicitis (with a retrocecal appendix): Although less common, an appendix located behind the cecum can cause groin pain due to its proximity to the psoas muscle, and the elevated WBC and neutrophils support an infectious process.
- Psoas abscess: An abscess in the psoas muscle can cause severe groin or lower back pain and elevated inflammatory markers. It's a less common condition but requires prompt diagnosis and treatment.
Rare Diagnoses
- Spermatic cord torsion: A rare condition where the spermatic cord becomes twisted, cutting off the blood supply to the testicle. It presents similarly to testicular torsion but is less common.
- Idiopathic granulomatous orchitis: A rare inflammatory condition of the testicles that can mimic infectious orchitis or testicular cancer but has a distinct granulomatous pathology.
- Henoch-Schönlein purpura (HSP): A systemic vasculitis that can cause groin pain among other symptoms like purpura, abdominal pain, and arthritis. It's rare in adults but can be considered in the differential diagnosis of unexplained groin pain with systemic symptoms.