Differential Diagnosis for a 9-Year-Old Boy with Pain in One Testicle Radiating to the Leg
Single Most Likely Diagnosis
- Testicular Torsion: This condition is a medical emergency where the spermatic cord becomes twisted, cutting off the blood supply to the testicle. It is characterized by sudden, severe testicular pain that can radiate to the groin and sometimes down to the leg. The pain is often accompanied by nausea, vomiting, and abdominal pain. Given the acute onset and the nature of the pain, testicular torsion is a highly plausible diagnosis.
Other Likely Diagnoses
- Epididymitis: This is an inflammation of the epididymis, a tube at the back of the testicle that stores and carries sperm. It can cause pain in the testicle that may radiate to the leg, and it's often associated with urinary symptoms such as dysuria or frequency. The pain typically develops over a few hours.
- Orchitis: Inflammation of one or both testicles, usually caused by bacterial or viral infections. It can cause testicular pain that may radiate, along with swelling, redness, and warmth of the scrotum.
- Varicocele: An enlargement of the veins within the scrotum, similar to varicose veins. While it's more commonly associated with a painless testicular mass, some individuals may experience a dull ache or sharp pain that could potentially radiate.
Do Not Miss Diagnoses
- Appendicitis: Although the primary symptom of appendicitis is abdominal pain, in some cases, especially if the appendix is located near the testicles (retrocecal appendix), the pain can be referred to the testicle. It's crucial to consider appendicitis due to its potential for severe complications if not promptly treated.
- Inguinal Hernia: A hernia can cause pain in the groin that may radiate to the testicle and down the leg, especially if the hernia becomes incarcerated or strangulated, which are medical emergencies.
- Kidney Stone: While kidney stones typically cause flank pain that radiates to the groin, in some cases, the pain can be referred to the testicle, especially if the stone is moving down the ureter.
Rare Diagnoses
- Testicular Cancer: Although rare in children, testicular cancer can cause a painless testicular mass or, less commonly, pain due to bleeding or other complications within the tumor.
- Henoch-Schönlein Purpura (HSP): A form of vasculitis that affects blood vessels and can cause a variety of symptoms, including testicular pain and swelling, along with the characteristic purpuric rash.
- Spermatic Cord Tumor: Tumors of the spermatic cord are rare and can cause testicular or groin pain, along with a palpable mass.