Differential Diagnosis for Left Testicular Pain in Adults

Primary Differential Diagnoses

The American College of Radiology suggests that germ cell testicular tumors constitute approximately 95% of all testicular tumors 3
Epididymitis is the most common cause of testicular pain in adults over 25 years, characterized by gradual onset of pain and may present with urinary frequency 1
The European Association of Urology recommends that testicular torsion must be ruled out urgently despite being rare in patients over 35 years of age, and requires surgical intervention within 6-8 hours to prevent testicular loss 1, 2

The American Urological Association recommends determining the exact timing and onset of pain, as abrupt onset suggests torsion, while gradual onset suggests epididymitis 1
Assessing for Prehn sign is essential, as pain relief with testicular elevation suggests epididymitis rather than torsion 1
Duplex Doppler ultrasound of the scrotum is the first-line imaging modality, with expected findings of enlarged epididymis with increased blood flow on Doppler for epididymitis, and decreased or absent blood flow for torsion 1

Significant overlap exists in clinical presentation between different causes of acute scrotal pain, making diagnosis challenging 1
False-negative Doppler evaluations occur in 30% or more of cases, particularly with partial torsion or spontaneous detorsion 1

Obtaining a detailed pain history, including onset, duration, severity, and associated symptoms, is crucial for diagnosis 1
Performing a focused physical examination, including assessment for Prehn sign, testicular position, swelling, and tenderness, is essential 1
Ordering urinalysis to evaluate for infection or inflammation, and obtaining urgent Duplex Doppler ultrasound to differentiate between diagnoses, are critical steps in management 1