What are the main differential diagnostic considerations of a painful scrotum?
The main differential diagnostic considerations of a painful scrotum are testicular torsion and epididymitis and/or orchitis. Testicular torsion is a surgical emergency and can be confirmed or excluded with duplex Doppler US or planar scintigraphy (using technetium-99m ( 99m Tc) pertechnetate as the radiotracer), although the latter is now rarely, if ever, used. A common cause of the painful hemiscrotum in a prepubertal male is paratesticular/epididymal inflammation secondary to torsion of the testicular or epididymal appendage ( Figure 88-7 ). Epididymitis due to infection is much more common in postpubescent boys than in younger boys and is identified on US by swelling of and increased blood flow in the epididymis. The cause of epididymitis is often bacterial, and there may be associated infection in the testicle as well.