Radiology Lectures | Radquarters

Ultrasound of Varicocele

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In this radiology lecture, we review the ultrasound appearance of scrotal varicocele with three unique cases.

Key teaching points include:

  • Varicocele is abnormal dilatation of pampiniform venous plexus = Peritesticular veins.
  • Seen in up to 15% of adult and adolescent males.
  • Caused by incompetent or absent testicular vein valves.
  • Upper limit of normal for scrotal vein caliber = 2 mm, varicocele when greater than 2-3 mm.
  • Flow in varicocele usually too slow to detect with color Doppler and is typically better seen with Valsalva or with standing position.
  • 85% left sided, 15% bilateral: Left testicular vein drains into left renal vein at 90-degree angle, and superior mesenteric artery compresses left renal vein = Increased pressure and venous backflow. Right vein drains into IVC at acute angle.
  • Symptoms: Scrotal mass, pain, infertility/subfertility.
  • Low grade: Reflux only seen with Valsalva, inguinal canal/supratesticular location, vessels enlarged only in standing position.
  • High grade: Reflux seen at rest, infratesticular location, vessels enlarged in supine position.
  • Solitary right varicocele raises concern for compression of the right testicular vein from a retroperitoneal mass.
  • Ultrasound of upper abdomen should be considered when an isolated right-sided varicocele or asymmetrically large right-sided varicocele found.
  • However, most patients typically present with additional signs and symptoms of malignancy: “No patient in our cohort was found to have an unsuspected malignancy for which isolated right-sided varicocele was the only presenting sign.”*

    • *Gleason A, Bishop K, Xi Y et al. Isolated Right-Sided Varicocele: Is Further Workup Necessary? AJR 2019; 212:802-807

    To learn more about the Samsung RS85 Prestige ultrasound system, please visit: https://www.bostonimaging.com/rs85-prestige-ultrasound-system-4

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    Radiology Lectures | RadquartersBy Daniel J. Kowal, MD
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