Left testicular varicocele - nutcracker phenomenon

Case contributed by Brendan Cullinane
Diagnosis almost certain

Presentation

Dull ache in the left scrotum

Patient Data

Age: 20 years
Gender: Male

Note: This case has been tagged as "legacy" as it no longer meets image preparation and/or other case publication guidelines.

Scrotal ultrasound: dilated, tortuous veins of the left pampiniform plexus with reflux demonstrated on Valsalva manoeuvre.

Therefore a left-sided testicular varicocele was demonstrated as the likely cause of the patient's symptoms.

The left testicular vein drains into the left renal vein (LRV). Extrinsic compression of the LRV is a potential cause of back pressure leading to a left testicular varicocele. The left renal vein passes between the superior mesenteric artery (SMA) and aorta (the left renal vein could not be demonstrated in the region between the SMA/aorta and the inferior vena cava).

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