58 year old man with a painless, palpable scrotal swelling inferior to his left testicle for 6 months. The swelling was firm, non-tender and could not be separated from the testicle on palpation.
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Ultrasound evaluation demonstrated normal testicles. 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 valsalva. Findings are consistent with a left varicocele thrombosis.
A varicocele is caused by dilatation of the pamfiniform plexus that drains the testicle, they occur more commonly on the left side due to anatomical variation. 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 imaging is the best method of diagnosis. Management is mostly conservative; however, can be surgical.