Left testicular varicocele - nutcracker phenomenon
Dull ache in the left scrotum
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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.