Differential Diagnosis for Moderate Right and Small Left Hydroceles with Bilateral Subcentimeter Epididymal Cysts

• Single Most Likely Diagnosis
  • Idiopathic Hydrocele with Epididymal Cysts: This is the most common cause of hydroceles and epididymal cysts, especially in the absence of other symptoms or risk factors. Hydroceles are accumulations of fluid in the tunica vaginalis surrounding the testes, and epididymal cysts are benign fluid-filled structures attached to the epididymis. Both conditions are often asymptomatic and discovered incidentally.
• Other Likely Diagnoses
  • Varicocele: Although not directly mentioned, varicoceles (enlargement of the veins within the scrotum) can sometimes be associated with hydroceles and epididymal abnormalities. They are more common on the left side but can occur bilaterally.
  • Inguinal Hernia: Though not directly related to hydroceles or epididymal cysts, inguinal hernias can sometimes cause scrotal swelling that might be confused with hydroceles, especially if the hernia extends into the scrotum.
• Do Not Miss Diagnoses
  • Testicular Tumor: It's crucial to rule out testicular cancer, which can present with a hydrocele or epididymal cyst as an initial finding. Although rare, missing a testicular tumor could have severe consequences.
  • Epididymitis or Orchitis: Inflammation of the epididymis (epididymitis) or testis (orchitis) can cause swelling and pain in the scrotum and might be associated with hydroceles or epididymal cysts. These conditions require prompt treatment to prevent complications.
• Rare Diagnoses
  • Lymphoma or Metastasis: Rarely, hydroceles or epididymal cysts can be associated with lymphoma or metastatic disease involving the testes or epididymis. These conditions are much less common but should be considered in the differential diagnosis, especially in patients with known cancer or unexplained systemic symptoms.
  • Filariasis: In endemic areas, filariasis (infection with filarial parasites) can cause hydroceles. This diagnosis would be rare in most clinical settings but should be considered in patients from or traveling to endemic areas.