Question
My husband, age 38, has lived with chronic pain for over 10 years now. From what I understand, it's in his left lower abdomen and radiates down into the left testicle. We have been to countless doctors through our insurance and so far, every doctor has basically told him to "live with it". Some have thought it may be due to the inguinal nerve or ligament, one thought it may be a hernia, but so far, we haven't had any answers. He has had a CAT scan of the area, tried physical therapy, a cortisone shot in the area and just recently, they finally did an MRI. The orthopedic doctor said that he couldn't see anything on the left hand side that was abnormal, and again, he also just kind of blew us off. I read the MRI report and it says that he has a right sided hydrocele, a 12mm cystic lesion in the right femoral head neck junction, and that the left testis was not identified, recommending following up with a testicular ultrasound. The doctor we saw didn't mention any of these findings at the appointment. What are these things and do you think that it may have anything to do with his pain? We are so frustrated at this point and are not sure which direction to go in. Thank you for your help.

Answer
Hi Mary,

This area isn't really my area of expertise but I can offer my opinion on the matter.

A hydrocele is a fluid-filled sac surrounding a testicle that results in swelling of the scrotum, the loose bag of skin underneath the penis. In adult males, a hydrocele can develop as a result of inflammation or injury within the scrotum. Inflammation may be the result of infection of the small coiled tube at the back of each testicle (epididymitis) or of the testicle (orchitis). Hydroceles do not usually result in pain but they can be a sign that there is inflammation in the area.

As for your husbands pain, one possibility is a chronic psoas muscle strain causing nerve impingement. The psoas muscle is a hip flexor and when it becomes tight  or irritated it can compress the nerves around the muscle that go to the testicle giving him lower abdominal pain and radiating pain to his testicle. A chronic psoas strain usually goes undetected for years because it can mimic organ pathology.

He can try seeing a chiropractor in his area to help determine if the psoas muscle is the cause of his pain. A tight psoas muscle cannot be detected with MRI and would require testing from a chiropractor, sports medicine physician or physiatrist.

Also, I would recommend that you talk to the doctor about the 'cystic lesion in the right femoral head' because without actually seeing the MRI I cannot interpret it.

I hope this helps!

Dr. Liza