Differential Diagnosis for a 25-year-old Male with a Higher Left Testicle
Single Most Likely Diagnosis
- Anatomical variation or spontaneous regression of a left varicocele: This could explain the asymmetry without pain, as varicoceles can sometimes resolve on their own or may not always be symptomatic.
Other Likely Diagnoses
- Left hydrocele: Although not painful, a hydrocele could cause the testicle to appear higher due to fluid accumulation around the testis.
- Left testicular atrophy: This could result from various causes, including previous trauma, infection, or torsion, leading to a smaller, potentially higher-positioned testicle.
- Idiopathic or congenital difference in testicular size or position: Some individuals naturally have differences in testicular size or position, which may become more noticeable over time.
Do Not Miss Diagnoses
- Testicular cancer: Although testicular cancer is typically associated with a painless testicular mass, any change in testicular size or position warrants consideration of this diagnosis due to its potential severity and the importance of early detection.
- Testicular torsion (partial or intermittent): While the patient denies pain, partial or intermittent torsion could potentially cause intermittent elevation of the testicle without constant pain.
- Epididymitis or orchitis (chronic or low-grade): Inflammation of the epididymis or testis could potentially cause changes in testicular position or size, even in the absence of significant pain.
Rare Diagnoses
- Polyarteritis nodosa or other vasculitides: These conditions can cause testicular symptoms, including changes in testicular size or position, due to inflammation of the blood vessels.
- Neurofibromatosis type 1 (NF1) with testicular involvement: NF1 can cause a variety of testicular and scrotal abnormalities, including neurofibromas that might affect testicular position.
- Previous or undiagnosed testicular torsion with resultant atrophy: If the patient had a previous episode of torsion that resolved without medical intervention, it could lead to atrophy and a change in testicular position.