Left testicular varicocele - nutcracker phenomenon

Case contributed by Brendan Cullinane

Presentation

Dull ache in the left scrotum

Patient Data

Age: 20 years
Gender: Male

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

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).
In this patient, the superior mesenteric artery and aorta abut one another causing compression of the left renal vein. The left renal vein is distended (arrow) due to this compression.In this case, nutcracker syndrome (compression of the left renal vein between the SMA and aorta) appears to be the underlying cause.

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Case information

rID: 19739
Published: 8th Oct 2012
Last edited: 3rd May 2019
Inclusion in quiz mode: Included

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