Differential Diagnosis for Testicular Pain Radiating to Thigh in a Diabetic Patient
Single Most Likely Diagnosis
- Diabetic neuropathy: The patient's long-standing uncontrolled diabetes and the presence of testicular pain radiating to the thigh suggest a possible neuropathic origin. Diabetic neuropathy can cause pain in various parts of the body, including the testicles, and can radiate to adjacent areas.
Other Likely Diagnoses
- Epididymitis: Inflammation of the epididymis, which can cause testicular pain and tenderness, is a possible diagnosis. The presence of right cord tenderness supports this possibility.
- Orchitis: Inflammation of one or both testicles, usually caused by bacterial or viral infections, could also explain the patient's symptoms.
- Varicocele: A varicocele is an enlargement of the veins within the scrotum, similar to varicose veins. It can cause aching pain and is more common on the left side but can occur on the right.
Do Not Miss Diagnoses
- Testicular torsion: Although less likely given the chronic nature of the pain, testicular torsion is a medical emergency that requires immediate attention. It can cause severe pain and tenderness.
- Testicular cancer: While the presence of multiple small, mobile lymph nodes might suggest a benign condition, testicular cancer with metastasis to lymph nodes cannot be ruled out without further investigation.
Rare Diagnoses
- Spermatocele: A spermatocele is a cystic structure that forms at the head of the epididymis and can cause discomfort or pain, though it's less likely to cause radiating pain to the thigh.
- Filariasis: In endemic areas, filariasis can cause lymphatic obstruction leading to scrotal swelling and pain, but it's less common and would typically present with more systemic symptoms.
- Henoch-Schönlein purpura (HSP): A systemic vasculitis that can cause testicular pain among other symptoms like purpura, arthritis, and abdominal pain. It's rare and usually seen in children but can occur in adults.