Oligospermia, left testicular pain with feeling of heaviness, clinically small left testis
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Longitudinal B-mode and color doppler scan of left testis show prominent tortuous tubular structures extending from the mediastinum towards the periphery showing venous flow consistent with diagnosis of intratesticular varicocele. Reflux was seen during Valsalva. Also there is extratesticular varicocele noted.
Intratesticular varicocele is a rare entity seen as dilated intratesticular veins usually seen in relation to the mediastinum testis. It is usually seen in the presence of ipsilateral extratesticular varicocele.
Most of the reported cases of intratesticular varicocle occur on the left side as is the case with extratesticular varicocele. The testicular pain is attributed to the stretching of tunica albuginea after active and passive congestion and dilatation of veins 1.
The three commonly recognisable patterns of intratesticular varicocele on ultrasound studies are:
- tubular (most common)
Increased incidence is noted in men who had undergone prepubertal orchidopexy for acquired undescended testis 2.
- 1. Das KM, Prasad K, Szmigielski W et-al. Intratesticular varicocele: evaluation using conventional and Doppler sonography. AJR Am J Roentgenol. 1999;173 (4): 1079-83. doi:10.2214/ajr.173.4.10511183 - Pubmed citation
- 2. Meij-de Vries A, den Bakker FM, van der Wolf-de Lijster FS et-al. High prevalence of intratesticular varicocele in a post-orchidopexy cohort. J Pediatr Urol. 2013;9 (3): 328-33. doi:10.1016/j.jpurol.2012.04.004 - Pubmed citation