Differential Diagnosis for Testicular Mass
- Single most likely diagnosis
- Spermatocele: The ultrasound findings of a mildly complex appearing right epididymal tail with no vascularity to suggest epididymitis are consistent with a spermatocele, which is a benign cystic structure that contains sperm. The marble-sized description also aligns with the typical presentation of a spermatocele.
- Other Likely diagnoses
- Epididymal cyst: Similar to a spermatocele but does not contain sperm, an epididymal cyst could present with similar ultrasound findings and is a common benign condition.
- Hydrocele: Although not directly mentioned, a hydrocele (fluid collection around the 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 specifically mentions 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. Any solid mass within the testicle would necessitate further evaluation.
- Epididymitis: Despite the ultrasound findings not suggesting epididymitis, clinical correlation is crucial. Epididymitis can present with a range of ultrasound findings, and missing this diagnosis could lead to significant morbidity if not treated promptly.
- Torsion: The ultrasound report mentions no evidence for torsion, but this is a clinical emergency that requires immediate attention. Any suspicion of torsion based on clinical presentation (severe pain, etc.) should prompt urgent evaluation regardless of initial imaging findings.
- Rare diagnoses
- Adrenal rest tumors: These are rare, benign tumors that can occur in the testes in patients with congenital adrenal hyperplasia. They are less likely but could present as a testicular mass.
- Epidermoid cysts: Benign cystic lesions that can occur within the testicle, epidermoid cysts are rare and might be considered if other diagnoses are ruled out.