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A left-sided testicular varicocoele was demonstrated and is the likely cause of the patients symptoms.
The left testicular vein drains into the left renal vein (LRV.) Extrinsic compression of the LRV is a potential cause of backpressure leading to a left testicular varicocoele. In this case, nutcracker syndrome (compression of the left renal vein between the SMA and aorta) appears to be the underlying cause.