Differential Diagnosis for Testicular Mass
- Single most likely diagnosis
- Spermatocele: The ultrasound finding of a mildly complex appearing right epididymal tail with no vascularity to suggest epididymitis is consistent with a spermatocele, which is a benign cystic structure filled with sperm, often found at the head of the epididymis.
- Other Likely diagnoses
- Epididymal cyst: Similar to a spermatocele but typically filled with clear fluid rather than sperm, epididymal cysts are also benign and common.
- Hydrocele: Although not directly mentioned, a hydrocele (fluid collection around a testicle) could potentially cause a mass-like effect and should be considered, especially if there's any mention of fluid collection.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Testicular cancer: Although the ultrasound shows no intratesticular mass, testicular cancer is a critical diagnosis not to miss due to its potential for rapid progression and high cure rate if caught early. It's essential to ensure that any solid components within the testicle are thoroughly evaluated.
- Epididymitis: Despite the ultrasound suggesting no vascularity indicative of epididymitis, this condition can present subtly, especially in its early stages. Missing epididymitis could lead to complications such as testicular infarction or abscess formation.
- Rare diagnoses
- Adrenal rest tumors: These are rare, benign tumors that can occur in the testicles, associated with congenital adrenal hyperplasia. They might appear as masses on ultrasound.
- Epidermoid cysts: Benign cystic lesions that can occur within the testicle, potentially mimicking more sinister pathology on imaging.