Epididymitis Differential Diagnoses

Updated: Jun 07, 2022
  • Author: Christina B Ching, MD; Chief Editor: Edward David Kim, MD, FACS  more...
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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