Varicocele

A varicocele, defined as a pathological enlargement of the pampiniform plexus with veins often running in a winding course,

The incidence of varicocele in males with primary (35%) and secondary (80%) infertility is significantly higher compared to the general male population (15%)

 

The etiology of varicocele is multifactorial. Differences in the course of testicular veins are considered to underlie the higher incidence of left-sided varicocele (>80% of cases). The left testicular vein runs vertically and enters the left renal vein at a right angle, which predisposes to turbulent blood flow and reverse pressure, while the right testicular vein opens directly into the inferior vena cava at a sharp angle().

Compression of the left renal or testicular vein, either as a result of the so-called nutcracker mechanism or due to renal or retroperi-toneal tumors, is a relatively rare cause of varicocele(). A sudden onset of varicocele in a man over the age of 30 years requires the exclusion of renal tumors, particularly in elderly patients. In such cases it is necessary to extend diagnostic ultrasonography with abdominal examination.

US in the long axis of the left spermatic cord shows enlarged veins consistent with a diagnosis of a varicocele
Ashley Davidoff MD 133546
47 M normal testes bilateral varicoceles
Ashley DAvidoff MD 133509
30 year old with pain Normal testes, probable left varicocele and scrotal pearl
Ashley Davidoff MD 133354
30 year old with pain Normal testes, left varicocele
Without Valsalva
Ashley Davidoff MD 133356
30 year old with pain Normal testes, left varicocele
Ashley Davidoff MD 133355
19 year old male with testicular discomfort. US in the supine position shows varicocele
Ashley Davidoff MD 133640
Without Valsalva
19 year old male with testicular discomfort. US in the supine position shows varicocele
Ashley Davidoff MD 133639
With Valsalva
19 year old male with testicular discomfort. US in the supine position shows varicocele
Ashley Davidoff MD 133636
T1 FS post gadolinium weighted sequence in the coronal plane through the left testis in a patient with an infarcted seminoma, and shows a prominent gonadal vein in the spermatic cord as it enters the cord and then becoming serpiginous in the distal portions of the cord.
Ashley Davidoff MD 133580L
T2 weighted sequence in the sagittal plane through the left testis in a patient with an infarcted seminoma, shows a prominent gonadal vein in the spermatic cord .
Ashley Davidoff MD 133630
T2 weighted sequence in the sagittal plane through the left testis in a patient with an infarcted seminoma, shows a prominent gonadal vein in the scrotal sac becoming serpiginous in the distal portions of the cord.
Ashley Davidoff MD 133632
Varicocele Gray Scale
Ashley Davidoff MD
24905
Varicocele Doppler showing high velocity flow
Ashley Davidoff MD 24906
Retrograde access to the enlarged left gonadal vein from the right femoral vein , and left renal vein prior to embolization
Ashley Davidoff MD 26573
Retrograde access to the enlarged left gonadal vein from the right femoral vein , and left renal vein prior to embolization
Ashley Davidoff MD 26574

 

Links and References

Lorenc T et al Ultrasound and Varicocele