Differential Diagnosis for Testicular Pain

The patient presents with testicular pain, low-grade fever, and a history of pain that began in the tailbone, moved to rectal pain, and radiated to the testicular area. Given these symptoms, the following differential diagnoses are considered:

• 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), can cause testicular pain, fever, and pain that may radiate from the lower back or rectal area. The patient's symptoms of testicular pain and low-grade fever, along with the progression of pain, make epididymitis a strong consideration.
• Other Likely Diagnoses
  • Prostatitis: Inflammation of the prostate gland can cause pain in the rectal area, lower back, and testicles. The patient's description of pain starting in the tailbone and radiating to the testicles could be consistent with prostatitis.
  • Testicular Torsion: Although the exam findings are mentioned for testicular torsion, it's crucial to consider this condition due to its emergency nature. However, the gradual onset of pain and radiation from the tailbone might be less typical for torsion, which usually presents with sudden, severe pain.
• Do Not Miss Diagnoses
  • Testicular Torsion: Despite being potentially less likely given the gradual onset, testicular torsion is a surgical emergency that must be ruled out due to the risk of testicular loss if not promptly treated.
  • Appendicitis: Although less common, appendicitis can sometimes present with pain that radiates to the testicles, especially if the appendix is located near the rectum or testicles. Missing appendicitis could lead to severe complications, including perforation.
• Rare Diagnoses
  • Orchitis: Inflammation of one or both testicles, usually caused by bacterial or viral infections. While it could explain the testicular pain, the radiation of pain from the tailbone and rectal area is less typical.
  • Referred Pain from Lumbar Disc Disease: In some cases, lumbar disc disease can refer pain to the testicles. However, this would be an uncommon presentation and would likely be accompanied by other symptoms such as back pain or sciatica.

Each of these diagnoses should be considered in the context of the patient's full clinical presentation, including history, physical examination, and any diagnostic tests that may be appropriate, such as ultrasound for testicular torsion or epididymitis, and potentially imaging or laboratory tests to evaluate for other conditions like prostatitis or appendicitis.