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Epididymitis Differential Diagnoses

  • Author: Christina B Ching, MD; Chief Editor: Edward David Kim, MD, FACS  more...
 
Updated: Dec 20, 2015
 
 

Diagnostic Considerations

Conditions to consider in the differential diagnosis of epididymitis include the following:

  • Testicular torsion
  • Scrotal hernia
  • Inguinal hernia
  • Idiopathic scrotal edema
  • Reactive hydrocele
  • Pyocele
  • Henoch-Schönlein purpura
  • Behçet disease
  • Polyarteritis nodosa
  • Vasculitis
  • Referred or radicular pain
  • Epididymal cyst
  • Epididymal congestion following vasectomy
  • Spermatocele
  • Testicular tumor (hemorrhage into tumor)
  • Tunica vaginalis tumors: Mesothelioma
  • Varicocele
  • Urinary tract infection

Differential Diagnoses

 
 
Contributor Information and Disclosures
Author

Christina B Ching, MD Clinical Assistant Professor, Division of Pediatric Urology, Nationwide Children's Hospital

Christina B Ching, MD is a member of the following medical societies: Alpha Omega Alpha, American Medical Student Association/Foundation, American Urological Association

Disclosure: Nothing to disclose.

Coauthor(s)

Edmund S Sabanegh, Jr, MD Chairman, Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic Foundation

Edmund S Sabanegh, Jr, MD is a member of the following medical societies: American Medical Association, American Society of Andrology, Society of Reproductive Surgeons, Society for the Study of Male Reproduction, American Society for Reproductive Medicine, American Urological Association, SWOG

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Edward David Kim, MD, FACS Professor of Surgery, Division of Urology, University of Tennessee Graduate School of Medicine; Consulting Staff, University of Tennessee Medical Center

Edward David Kim, MD, FACS is a member of the following medical societies: American College of Surgeons, Tennessee Medical Association, Sexual Medicine Society of North America, American Society for Reproductive Medicine, American Society of Andrology, American Urological Association

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Repros.

Additional Contributors

Erik T Goluboff, MD Professor, Department of Urology, College of Physicians and Surgeons, Columbia University College of Physicians and Surgeons; Director of Urology, Allen Pavilion, New York Presbyterian Hospital

Erik T Goluboff, MD is a member of the following medical societies: Alpha Omega Alpha, American Medical Association, American Urological Association, Medical Society of the State of New York, New York Academy of Medicine, Phi Beta Kappa, Society for Basic Urologic Research

Disclosure: Nothing to disclose.

Acknowledgements

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous authors Michael Franks, MD, and Badrinath R Konety, MD, to the development and writing of the source article.

References
  1. Trei JS, Canas LC, Gould PL. Reproductive tract complications associated with Chlamydia trachomatis infection in US Air Force males within 4 years of testing. Sex Transm Dis. 2008 Sep. 35(9):827-33. [Medline].

  2. Nusbaum MR, Wallace RR, Slatt LM, Kondrad EC. Sexually transmitted infections and increased risk of co-infection with human immunodeficiency virus. J Am Osteopath Assoc. 2004 Dec. 104(12):527-35. [Medline].

  3. Santillanes G, Gausche-Hill M, Lewis RJ. Are antibiotics necessary for pediatric epididymitis?. Pediatr Emerg Care. 2011 Mar. 27(3):174-8. [Medline].

  4. Raveenthiran V, Sam CJ. Epididymo-orchitis complicating anorectal malformations: collective review of 41 cases. J Urol. 2011 Oct. 186(4):1467-72. [Medline].

  5. Siegel A, Snyder H, Duckett JW. Epididymitis in infants and boys: underlying urogenital anomalies and efficacy of imaging modalities. J Urol. 1987 Oct. 138(4 Pt 2):1100-3. [Medline].

  6. Viswaroop BS, Kekre N, Gopalakrishnan G. Isolated tuberculous epididymitis: a review of forty cases. J Postgrad Med. 2005 Apr-Jun. 51(2):109-11, discussion 111. [Medline].

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  8. Rizvi SA, Ahmad I, Siddiqui MA, Zaheer S, Ahmad K. Role of color Doppler ultrasonography in evaluation of scrotal swellings: pattern of disease in 120 patients with review of literature. Urol J. 2011. 8(1):60-5. [Medline].

  9. Yu KJ, Wang TM, Chen HW, Wang HH. The dilemma in the diagnosis of acute scrotum: clinical clues for differentiating between testicular torsion and epididymo-orchitis. Chang Gung Med J. 2012 Jan-Feb. 35(1):38-45. [Medline].

  10. Waldert M, Klatte T, Schmidbauer J, Remzi M, Lackner J, Marberger M. Color Doppler sonography reliably identifies testicular torsion in boys. Urology. 2010 May. 75(5):1170-4. [Medline].

  11. Yusuf G, Sellars ME, Kooiman GG, Diaz-Cano S, Sidhu PS. Global testicular infarction in the presence of epididymitis: clinical features, appearances on grayscale, color Doppler, and contrast-enhanced sonography, and histologic correlation. J Ultrasound Med. 2013 Jan. 32(1):175-80. [Medline].

  12. Siu W, Ohl DA, Schuster TG. Long-term follow-up after epididymectomy for chronic epididymal pain. Urology. 2007 Aug. 70(2):333-5; discussion 335-6. [Medline].

  13. Taylor SN. Epididymitis. Clin Infect Dis. 2015 Dec 15. 61 Suppl 8:S770-3. [Medline].

  14. [Guideline] 2015 Sexually Transmitted Diseases Treatment Guidelines: Epididymitis. Centers for Disease Control and Prevention. Available at http://www.cdc.gov/std/tg2015/epididymitis.htm. Accessed: December 19, 2015.

  15. Chung JH, Moon HS, Choi HY, et al. Inhibition of Adhesion and Fibrosis Improves the Outcome of Epididymectomy as a Treatment for Chronic Epididymitis: a multicenter, randomized, controlled, single blind study. J Urol. 2012 Dec 3. [Medline].

  16. Lee JY, Lee TY, Park HY, Choi HY, Yoo TK, Moon HS. Efficacy of epididymectomy in treatment of chronic epididymal pain: a comparison of patients with and without a history of vasectomy. Urology. 2011 Jan. 77(1):177-82. [Medline].

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Cross-section illustration of a testicle and epididymis. A: Caput or head of the epididymis. B: Corpus or body of the epididymis. C: Cauda or tail of the epididymis. D: Vas deferens. E: Testicle. Illustration by David Schumick, BS, CMI. Reprinted with the permission of the Cleveland Clinic Center for Medical Art and Photography © 2009. All Rights Reserved.
Color Doppler sonogram of the left epididymis in a patient with acute epididymitis. The image demonstrates increased blood flow in the epididymis resulting from the active inflammation.
Scrotal sonogram demonstrating the presence of a hydrocele and an enlarged epididymis in a patient with epididymitis. The echogenic white area is the normal testicle surrounded by the hydrocele.
Scrotal sonogram showing the testes adjacent to the inflamed epididymis with a reactive hydrocele.
 
 
 
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