Differential Diagnosis for 34yo M with Abdominal Pain and Testicular Symptoms
- Single most likely diagnosis:
- Inguinal hernia: The patient's symptoms of abdominal pain and a sensation of something pulling on his left testicle, combined with the negative test results for appendicitis, make inguinal hernia a plausible diagnosis. The pain can radiate to the upper and lower abdomen, and the hernia can cause a pulling sensation on the testicle.
- Other Likely diagnoses:
- Epididymitis: The patient's symptoms of testicular pain and pulling sensation could be indicative of epididymitis, an inflammation of the epididymis.
- Testicular torsion (partial): Although the patient had a negative CT scan, partial testicular torsion can be intermittent and may not always be visible on imaging.
- Abdominal wall strain: The patient's abdominal pain could be due to a strain of the abdominal wall muscles, which can cause referred pain to the testicles.
- Do Not Miss diagnoses:
- Testicular cancer: Although rare, testicular cancer can present with a sensation of heaviness or pulling in the testicle, and it is essential to rule out this diagnosis.
- Ovarian torsion (in rare cases of ovotestes): Although extremely rare in males, ovarian torsion can occur in individuals with ovotestes, and it is a medical emergency.
- Retroperitoneal hemorrhage: A bleeding disorder or trauma can cause a retroperitoneal hemorrhage, which can present with abdominal pain and testicular symptoms.
- Rare diagnoses:
- Varicocele: A varicocele is an enlargement of the veins within the scrotum, which can cause a pulling sensation on the testicle.
- Spermatocele: A spermatocele is a cystic structure that can cause a sensation of heaviness or pulling in the testicle.
- Abdominal aortic aneurysm: Although rare in young individuals, an abdominal aortic aneurysm can cause abdominal pain and referred pain to the testicles.