Acute orchitis

Acute epididymitis

Testicular torsion

Inguinal hernia

Hydrocele

Varicocele

Spermatocele

Inguinal hernia

Inguinal adenopathy

Muscle strain

Local abscess or inguinal lymphadenopathy in the setting of lower extremity infection or a urethral discharge poses no great diagnostic difficulty.

Fever is commonly noted in patients with orchitis or epididymitis.

Inguinal hernia may contain bowel loops; therefore, on auscultation, bowel sounds may be noted.

Direct and indirect inguinal hernias may be readily palpated in the upright patient and may be reducible with recumbency or Trendelenburg position and slight pressure; if they are not, however, or if significant tenderness is present, incarceration must be ruled out.

A hydrocele or spermatocele may be transilluminated, whereas an inflamed epididymis, a torsed testicle, or a hernia generally cannot be.

Varicoceles are most commonly seen on the left because the venous drainage of the left testicle occurs into the left renal vein.

Examination of the lower extremity, particularly the toes, may demonstrate an infectious process responsible for inguinal adenopathy.

Swelling, retraction, and severe discomfort are important signs of testicular torsion.

Testicular elevation in patients with orchitis (Prehn sign) often causes some improvement in pain and may therefore be a useful, although absolutely not a definitive, diagnostic maneuver.

Enhancement of inguinal area discomfort associated with movement of the extremity against resistance is found in patients with musculoligamentous injuries; to elicit such discomfort, internal or external rotation of the leg against resistance is often helpful.

The white blood count is normal or mildly elevated in orchitis or epididymitis but may be significantly elevated in patients with incarcerated hernia.

An abdominal CT will prove the diagnosis in patients with a possible incarcerated obstructing inguinal hernia.

Color Doppler ultrasound is now considered the diagnostic procedure of choice in patients suspected of torsion; also potentially seen by ultrasound are an edematous epididymis, a varicocele, or a spermatocele.