Differential Diagnosis for Testicular Pain and Enlarged Vein in a 20yo Male

• Single most likely diagnosis:

  • Varicocele: This condition is characterized by an enlargement of the veins within the scrotum, similar to varicose veins in the legs. It is a common cause of testicular pain and swelling, particularly on the left side, and can be associated with infertility issues. The presentation of testicular pain and an enlarged vein strongly suggests this diagnosis.

• Other Likely diagnoses:

  • Epididymitis: Inflammation of the epididymis, usually due to bacterial infection, can cause testicular pain and swelling. It might also lead to an enlarged vein due to increased blood flow to the area.
  • Hydrocele: Although primarily known for causing swelling due to fluid accumulation around a testicle, a hydrocele can sometimes be associated with discomfort and might be considered in the differential, especially if the pain is mild and there's noticeable swelling.
  • Spermatocele: A cystic structure filled with sperm that arises from the head of the epididymis, which can cause a sensation of heaviness or discomfort and might be associated with an enlarged vein due to its location and potential for causing local inflammation.

• Do Not Miss diagnoses:

  • Testicular Torsion: A medical emergency where the spermatic cord becomes twisted, cutting off the blood supply to the testicle. It presents with sudden, severe testicular pain, swelling, and possibly an elevated testicle. Although the primary symptom is pain rather than an enlarged vein, torsion can lead to changes in the scrotal appearance, including swelling that might be mistaken for an enlarged vein.
  • Testicular Cancer: While less common, testicular cancer can cause pain and swelling. An enlarged vein could be a sign of increased blood flow to a tumor. Early detection is crucial for effective treatment.

• 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 young adults.
  • Filariasis: In endemic areas, filarial infection can cause lymphatic obstruction leading to severe swelling (elephantiasis) and could potentially cause testicular pain and an enlarged vein due to lymphatic involvement. However, this would be extremely rare in a 20-year-old male without travel history to endemic areas.