Differential Diagnosis for 27 y/o with 48 hours of right-sided testicular pain
- Single most likely diagnosis
- Epididymitis: This is the most likely diagnosis given the acute onset of testicular pain, which is often accompanied by inflammation of the epididymis, usually due to a bacterial infection. The pain can be severe and is typically unilateral.
- Other Likely diagnoses
- Testicular torsion (early presentation): Although testicular torsion is a medical emergency, early presentation might not show all the classic signs. It's essential to consider this diagnosis due to its urgency, even if the patient does not exhibit all typical symptoms like severe pain, nausea, vomiting, and a horizontal lie of the testis.
- Orchitis: Inflammation of one or both testicles, usually caused by bacterial or viral infections. It can present with testicular pain and swelling.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed)
- Testicular torsion (late presentation): Even if the patient has had pain for 48 hours, testicular torsion can still occur and is a surgical emergency. Delayed diagnosis can lead to loss of the testicle and potential long-term fertility issues.
- Testicular cancer with acute hemorrhage or torsion of a testicular appendage: Although rare, testicular cancer can present acutely if there's a hemorrhage or if a testicular appendage undergoes torsion, leading to severe pain.
- Rare diagnoses
- Henoch-Schönlein purpura (HSP) involving the testes: A systemic vasculitis that can rarely involve the testes, leading to pain and swelling.
- Polyarteritis nodosa (PAN) involving the testicular arteries: A systemic necrotizing vasculitis that can involve any organ, including the testes, though this is exceedingly rare.
- Spermatic cord thrombosis: A rare condition that can mimic testicular torsion in its presentation, requiring prompt diagnosis and treatment to preserve testicular function.