Diagnostic Considerations

Epididymitis must be differentiated from testicular torsion, which is a true urologic emergency.^[14]Idiopathic scrotal pain and orchialgia can be misdiagnosed as epididymitis. With a proper evaluation and careful physical examination, however, these entities can be distinguished from each other and a proper diagnosis obtained.

Other conditions to consider in the differential diagnosis of epididymitis include the following:

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

Other rare causes of scrotal pain include^[15]:

Acute appendicitis
Acute pancreatitis
Acute aortic syndrome
Thrombosis of the spermatic vein or pampiniform plexus

Differential Diagnoses

Workup

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Media Gallery

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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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 Urology, Department 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 Society for Reproductive Medicine, American Urological Association, Sexual Medicine Society of North America, Society for Male Reproduction and Urology, Society for the Study of Male Reproduction, Tennessee Medical Association

Disclosure: Nothing to disclose.

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.

Epididymitis Differential Diagnoses

Diagnostic Considerations

Differential Diagnoses

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