Ultrasound of Varicocele

In this radiology lecture, we review the ultrasound appearance of scrotal varicocele with three unique cases. Key teaching points include: 1) Varicocele is abnormal dilatation of pampiniform venous plexus = Peritesticular veins. 2) Seen in up to 15% of adult and adolescent males. 3) Caused by incompetent or absent testicular vein valves. 4) Upper limit of normal for scrotal vein caliber = 2 mm, varicocele when greater than 2-3 mm. 5) Flow in varicocele usually too slow to detect with color Doppler and is typically better seen with Valsalva or with standing position. 6) 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. 7) Symptoms: Scrotal mass, pain, infertility/subfertility. 8) Low grade: Reflux only seen with Valsalva, inguinal canal/supratesticular location, vessels enlarged only in standing position. 9) High grade: Reflux seen at rest, infratesticular location, vessels enlarged in supine position. 10) Solitary right varicocele raises concern for compression of the right testicular vein from a retroperitoneal mass. 11) Ultrasound of upper abdomen should be considered when an isolated right-sided varicocele or asymmetrically large right-sided varicocele found. 12) 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-pr... Click the YouTube Community tab or follow on social media for bonus teaching material posted throughout the week! Website: http://www.radiologistHQ.com Video Podcast: http://bit.ly/radiologistHQ Instagram:   / radiologisthq   Facebook:   / radiologistheadquarters   Twitter:   / radiologisthq