Differential Diagnosis for Testicular Swelling
The differential diagnosis for testicular swelling is broad and includes various conditions that can be categorized based on their likelihood and potential impact on patient health.
Single Most Likely Diagnosis
- Epididymitis: This is an inflammation of the epididymis, usually caused by bacterial infection. It's the most common cause of acute testicular pain and swelling in young men, especially those under 35. The justification for considering epididymitis as the single most likely diagnosis lies in its high prevalence among men of reproductive age and its association with sexually transmitted infections or urinary tract infections.
Other Likely Diagnoses
- Orchitis: Inflammation of one or both testicles, often caused by viral or bacterial infections. It can occur alone or in conjunction with epididymitis (epididymo-orchitis).
- Hydrocele: An accumulation of fluid in the tunica vaginalis, a potential space around the testicle, leading to swelling of the scrotum.
- Varicocele: An enlargement of the veins within the scrotum, similar to varicose veins in the legs. It's more common on the left side and can cause a feeling of heaviness or swelling.
- Testicular Torsion: A twisting of the spermatic cord that cuts off the blood supply to the testicle. It's a medical emergency that requires immediate attention.
- Spermatocele: A cystic structure filled with sperm that arises from the head of the epididymis. It's usually painless and can cause swelling.
Do Not Miss Diagnoses
- Testicular Torsion: Although mentioned earlier, it's crucial to reiterate due to its emergency nature. Delayed diagnosis can lead to loss of the testicle.
- Testicular Cancer: While less common, testicular cancer can present with a painless testicular mass or swelling. Early detection is key for effective treatment.
- Acute Appendicitis (with an atypical presentation): In some cases, appendicitis can present with testicular pain or swelling if the appendix is located near the testicles.
Rare Diagnoses
- Henoch-Schönlein Purpura (HSP): A form of vasculitis that can cause testicular swelling among other symptoms like purpura, joint pain, and gastrointestinal issues.
- Filariasis: In endemic areas, filariasis can cause hydrocele and other genital manifestations due to parasitic infection.
- Sarcoidosis: A systemic disease that can rarely cause testicular swelling due to granulomatous inflammation.
Each diagnosis has distinct characteristic findings that can guide the clinical evaluation and diagnostic approach. For instance, testicular torsion typically presents with acute, severe pain and a horizontal lie of the testis, while epididymitis may have a more gradual onset of pain and be associated with signs of infection like fever and urethral discharge. Testicular cancer often presents as a painless testicular mass. Understanding these differences is crucial for accurate diagnosis and timely management.