Varicocele

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[edit] Discussion of Varicocele

  • Varicoceles are the most frequently encountered mass of the spermatic cord.
  • May either be idiopathic, likely resulting from incompetent valves within the testicular veins, or develop secondary to an abdominal mass (typically renal cell carcinoma) that compresses or invades the renal veins or inferior vena cava.
  • An abdominal mass should always be suspected when an older man presents with a new varicocele.
  • Idiopathic varicoceles generally on the left or are bilateral. Isolated right varicocele should raise the suspicious for an abdominal mass.
    • Left-sided predominance is likely secondary to the longer course and more perpendicular insertion of the left testicular vein into the left renal vein.
    • The right testicular vein has a shorter course and a direct, oblique insertion into the inferior vena cava that creates less backpressure than on the left.
  • Varicoceles have been noted in approximately 15% of the general population and in up to 40% of men with infertility.
  • The exact connection between varicoceles and infertility is unclear, but the most commonly accepted theory is that varicoceles increase scrotal temperature, which negatively affects spermatogenesis.

[edit] Imaging Findings for Varicocele

[edit] US

  • Normal vessels within the pampiniform plexus can range up to 1.5 mm in diameter but are often not visualized.
  • Size limit for normal varies, with some using 2 mm for the diagnosis of a varicocele and others using 3 mm.
  • On gray-scale US scans, varicoceles appear as multiple serpiginous, anechoic structures superior and posterior to the testis.
  • On color-doppler images, varicoceles will expand and demonstrate flow reversal when the Valsalva maneuver is performed.

[edit] MRI

  • Varicoceles may be incidentally noted during a scrotal MR imaging examination.
  • The signal intensity varies according to blood flow velocity.
    • Slow-flowing varicoceles often have intermediate signal intensity on T1-weighted images and high signal intensity on T2-weighted images.
    • A signal void may be seen in those with higher velocity flow.
    • They enhance with gadolinium administration.


[edit] Images

Patient #1

Patient #2: Varicocele secondary to tumor

[edit] External Links

Goldminer: Varicocele

[edit] References for Varicocele

Paula J. Woodward, Cornelia M. Schwab, and Isabell A. Sesterhenn. From the Archives of the AFIP: Extratesticular Scrotal Masses: Radiologic-Pathologic Correlation.RadioGraphics 2003 23: 215-240.