Varicocele thrombosis

Case contributed by Ciara O Brien
Diagnosis certain

Presentation

Painless, palpable scrotal swelling inferior to the left testis for 6 months. The swelling was firm and non-tender and could not be separated from the testis on palpation.

Patient Data

Age: 60 years
Gender: Male

Scrotal Ultrasound

ultrasound

Ultrasound evaluation demonstrated normal testes. There is a moderate-sized left varicocele with echogenic debris demonstrated within the dilated left veins. Color Doppler flow within the left varicocele is significantly diminished and increased minimally with the Valsalva maneuver. Findings are consistent with a left varicocele thrombosis.
The yellow arrow points to a simple epididymal cyst surrounded by thrombosed veins of the varicocele.

Case Discussion

A varicocele is caused by dilatation of the pampiniform plexus that drains the testis They occur more commonly on the left side. Thrombosis of a varicocele is very rare. Patients may present with acute scrotal pain mimicking a testicular torsion or strangulated hernia. Diagnosis is difficult when based solely on clinical history and examination. Ultrasound with Doppler interrogation is the best method of diagnosis. Management is mostly conservative; however, can be surgical.

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