IS Case 278: Varicocele
Imaging Sciences URMC 2009
Publication Date: 2009-08-05
History
Patient is a 30-year-old male with left testicular pain
Findings
Bilateral testicles and epididymis are normal in appearance. There is a small left-sided varicocele, about 0.35 cm.
Diagnosis
Discussion
A varicocele is an area of abnormally dilated and tortuous veins. It most commonly occurs in the pampiniform plexus, which is posterior to the testis and adjacent to the epididymis and vas deferens.
There are two types of varicoceles: idiopathic, which is caused by incompetent valves, and secondary, which results for increased venous pressure downstream (which can be secondary to hepatomegaly, abdominal mass, or hydronephrosis for example).
Idiopathic varicoceles are more common, and occur on the left side in almost 98% of cases. This is thought to occur because the left gonadal vein drains into the left renal vein, while the right gonadal vein drains into the IVC. Idiopathic varicocele is the most common cause of male infertility.
Diagnosis is with ultrasound, where a varicocele appears as an anechoic, tubular structure that is more the 2mm in diameter. It follow a tortuous, or "serpentine" path, with multicystic collections. Spectral/color Doppler is useful in differentiating a varicocele from a spermatocele (which can have a similar gray-scale appearance) by demonstrating blood flow in the vessels.
While most varicoceles are asymptomatic, patients may have pain, a feeling of heaviness, or even be able to feel the enlarged veins. Treatment is usually in the form of scrotal support with undergarments; in severe cases, the varicocele may need to be surgically ligated or interventionally embolized.
References
- Rumack CM , Wilson SR, Charboneau JW. Diagnostic Ultrasound, 3rd ed., Mosby, 2004.
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