Presentation
Left scrotal swelling and pain for one month. Palpable left-sided mass on clinical examination.
Patient Data
Both testicles are orthotopic, with normal sizes and ellipsoidal shapes. They have normal vascularity as well.
The size of the right pampiniform plexus is normal, measuring 1.6 mm. In the Valsalva maneuver, there is no reflux.
Multiple dilated serpiginous vessels are visible in the left pampiniform plexus in both supine and erect positions. There are also numerous dilated left-sided intra-scrotal veins seen along the left testis and extending to the lower pole of the testis in both standing and supine positions. The largest measures 3.8 mm while supine and up to 4 mm when standing. On the Valsalva maneuver, they show reflux lasting more than 3 seconds.
Case Discussion
The dilated and serpiginous veins on the left side are consistent with grade III varicocele.
Varicocele is characterized by the enlargement of the veins in the scrotum. Because of the structure of the venous drainage, it is most typically encountered on the left side. It happens when the vein valves that regulate blood flow become weakened or damaged, causing blood to pool and the veins to expand. This can cause discomfort and pain and, in some instances, affect fertility.
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