Differentials
Testicular torsion
SIGNS / SYMPTOMS
Usually presents with sudden-onset severe unilateral scrotal pain.
Should be considered as a differential diagnosis in all male patients presenting with acute scrotal pain, particularly when there is an absence of symptoms and signs suggesting an infectious cause, such as urinary frequency, painful micturition, and urethral discharge.
Occurs more frequently in adolescents, but can occur in all age groups.
Torsion is rare in patients aged >35 years.[35]
INVESTIGATIONS
Negative Prehn sign: there is no pain relief when the affected hemiscrotum is elevated.
Color duplex ultrasonography has been shown to be useful in differentiating between torsion and inflammatory pathology in cases where the history and clinical findings are equivocal.[34]
However, there should be no delay in performing scrotal exploration in cases where testicular torsion is considered a likely differential diagnosis.
Acute idiopathic scrotal edema
SIGNS / SYMPTOMS
Usually affects the pediatric population, but has been reported in adults.[36]
Acute onset of redness and edema, but usually painless.
Can be unilateral or bilateral.
INVESTIGATIONS
Usually diagnosed clinically. Ultrasonography can be used to confirm the diagnosis.
Infected hydrocele
SIGNS / SYMPTOMS
History of preexisting hydrocele.
INVESTIGATIONS
Ultrasonography confirms the presence of a hydrocele containing turbid fluid, with a normal appearance of, and blood flow to, the epididymis and testis.
Strangulated inguinal hernia
SIGNS / SYMPTOMS
History of previous intermittent inguinoscrotal swelling, with or without pain.
Sudden onset of pain and inability to reduce the hernia. Associated nausea and vomiting.
May be difficult to palpate the testis and epididymis with a large strangulated inguinal hernia.
INVESTIGATIONS
Usually diagnosed clinically or on ultrasonography.
Testicular tumor
SIGNS / SYMPTOMS
Usually a painless swelling of gradual onset, but can mimic an epididymitis in some malignant presentations. This is usually due to the presence of a superior polar tumor in the rete testis.
INVESTIGATIONS
Ultrasonography will confirm the presence of a testicular tumor.
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