Ultrasound Case 105
A 22 year old man presents anxious he has noted a swelling in his scrotum. It is bigger when he stands up, and feels like a bag of worms.
View 2: During valsalva
Describe and interpret these scans
Image 1: Left hemiscrotum scanning from superior to inferior down cord then through testis.
The dilated anechoic veins of the pampinifomr plexus are demonstrated. This is a varicocele.
Image 2: Varicocele during valsalva.
The Valsalva manouvre increases intraabdominal pressure and there is brief backflow through the dilated veins of the panpiniform plexus.
Image 3: Panoramic view of the left hemiscrotum cranial to caudal.
Image 4: Transverse view of the epigastrium showing the left renal vein.
The left renal vein is seen being partially compressed by the superior mesenteric artery against the aorta as it crosses from the kidney between the two, to join the IVC.
Varicocele is a common diagnosis.
Traditional teaching emphasized the importance of assessing for a retroperitoneal tumour or tumour invading the left renal vein in cases of varicocele. This is to determine whether the varicocele was caused by interruption of the venous return of the left testicular vein which drains into the left renal vein.
The truth is that varicoceles are common, and retroperitoneal tumours and tumour invading the left renal vein are rare. In addition where a tumour does exist it has usually become apparent by the stage a varicocele has developed through other manifestations.
Where a varicocele rapidly develops particularly in older men, or where history provides other suggestions or renal or retroperitoneal pathology it is important to scan the left kidney and renal vein. In cases of a simple varicocele in an otherwise asymptomatic young man the yield of retroperitoneal and renal scanning will be extremely low.
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An Emergency physician based in Perth, Western Australia. Professionally my passion lies in integrating advanced diagnostic and procedural ultrasound into clinical assessment and management of the undifferentiated patient. Sharing hard fought knowledge with innovative educational techniques to ensure knowledge translation and dissemination is my goal. Family, wild coastlines, native forests, and tinkering in the shed fills the rest of my contented time. | SonoCPD | Ultrasound library | Top 100 | @thesonocave |