Varicocele - grade 4

Case contributed by Ian Bickle
Diagnosis almost certain


Medical assessment for work. Left paratesticle mass. Cause?

Patient Data

Age: 20 years
Gender: Male

Multiple dilated serpingeous vessels superior to the upper pole of the left testicle.  These measure upto 4mm even in the supine postion.

Avid doppler flow within.   The appearances are exaggerated during standing and the Valsala maneourve.  No flow reversal.

Normal right hemiscrotum.

Case Discussion

These are the classical appearances of a varicocele.  A varicocoele is the dilatation of the pampiniform plexus of veins, a network of many small veins found in the male spermatic cord.

This is the appearance of the so-called 'bag of worms' felt clinically on examination.

The veins were dilated even in the supine resting position in keeping with a Grade 4 varicocele.

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