eMedicine Specialties > Radiology > Genitourinary

Varicocele: Multimedia

Author: Ali Nawaz Khan, MBBS, FRCS, FRCP, FRCR, LRCP, Chairman of Medical Imaging, Professor of Radiology, NGHA, King Fahad National Guard Hospital, King Abdulaziz Medical City, Riyadh, Saudi Arabia
Coauthor(s): Sumaira MacDonald, MBChB, PhD, MRCP, FRCR, Lecturer, Sheffield University Medical School; Endovascular Fellow, Sheffield Vascular Institute; Klaus L Irion, MD, PhD, Consulting Staff, The Cardiothoracic Centre Liverpool NHS Trust, The Royal Liverpool University Hospital, UK
Contributor Information and Disclosures

Updated: Jul 10, 2008

Multimedia

Longitudinal sonogram through the left testicle. ...Media file 1: Longitudinal sonogram through the left testicle. This image shows several large anechoic tubes (2.4-6 mm in diameter) lying behind the upper and middle poles of the testicle. The diameter of these tubes increased by 1.5-2 mm with a Valsalva maneuver (not shown). T = testicle; v = varicocele.
Longitudinal sonogram through the left testicle. ...

Longitudinal sonogram through the left testicle. This image shows several large anechoic tubes (2.4-6 mm in diameter) lying behind the upper and middle poles of the testicle. The diameter of these tubes increased by 1.5-2 mm with a Valsalva maneuver (not shown). T = testicle; v = varicocele.

Transverse ultrasonography scan through the left ...Media file 2: Transverse ultrasonography scan through the left testicle. This image shows several cystic structures (2.4-4 mm in diameter) behind the testis. Color flow Doppler image demonstrates flow within these cystic structures (not shown).
Transverse ultrasonography scan through the left ...

Transverse ultrasonography scan through the left testicle. This image shows several cystic structures (2.4-4 mm in diameter) behind the testis. Color flow Doppler image demonstrates flow within these cystic structures (not shown).

<I>Upper image:</I> Longitudinal sonogram through...Media file 3: Upper image: Longitudinal sonogram through the pampiniform plexus of the left testis. The image shows several anechoic tubes. Lower image: The application of color Doppler imaging in the same patient shows bidirectional flow within the anechoic tubes.
<I>Upper image:</I> Longitudinal sonogram through...

Upper image: Longitudinal sonogram through the pampiniform plexus of the left testis. The image shows several anechoic tubes. Lower image: The application of color Doppler imaging in the same patient shows bidirectional flow within the anechoic tubes.

Left testicular venogram. This image shows a left...Media file 4: Left testicular venogram. This image shows a left testicular varicocele before embolization. Note: radiographs of varicoceles should be avoided to restrict radiation exposure.
Left testicular venogram. This image shows a left...

Left testicular venogram. This image shows a left testicular varicocele before embolization. Note: radiographs of varicoceles should be avoided to restrict radiation exposure.

Digital subtraction angiogram. This image shows s...Media file 5: Digital subtraction angiogram. This image shows several coils (arrows) overlying the left of the fifth lumbar vertebral body after embolization of the left testicular vein.
Digital subtraction angiogram. This image shows s...

Digital subtraction angiogram. This image shows several coils (arrows) overlying the left of the fifth lumbar vertebral body after embolization of the left testicular vein.

Line diagram of a typical bidirectional Doppler r...Media file 6: Line diagram of a typical bidirectional Doppler recording of a stop-type varicocele (red) in which flow is stopped by a competent valve in the pampiniform plexus above the level of communicating veins. The shunt-type of varicocele is depicted in blue. Because the valves in the pampiniform plexus contiguous to the testicular veins are incompetent or absent, venous flow is shunted via communicating veins into orthograde draining veins; these are shown to represent deferential and cremasteric veins at contrast venography.

On bidirectional Doppler sonograms, steady flow is recorded in both retrograde and orthograde fashions. Note: Several factors affect the flow, including the position of the patient, Valsalva maneuvers, and the position of the probe.

Line diagram of a typical bidirectional Doppler r...

Line diagram of a typical bidirectional Doppler recording of a stop-type varicocele (red) in which flow is stopped by a competent valve in the pampiniform plexus above the level of communicating veins. The shunt-type of varicocele is depicted in blue. Because the valves in the pampiniform plexus contiguous to the testicular veins are incompetent or absent, venous flow is shunted via communicating veins into orthograde draining veins; these are shown to represent deferential and cremasteric veins at contrast venography.

On bidirectional Doppler sonograms, steady flow is recorded in both retrograde and orthograde fashions. Note: Several factors affect the flow, including the position of the patient, Valsalva maneuvers, and the position of the probe.

Sonogram depicting a combination of an intratesti...Media file 7: Sonogram depicting a combination of an intratesticular and extratesticular right-sided varicocele.
Sonogram depicting a combination of an intratesti...

Sonogram depicting a combination of an intratesticular and extratesticular right-sided varicocele.

Sonogram depicting a combination of an intratesti...Media file 8: Sonogram depicting a combination of an intratesticular and extratesticular right-sided varicocele.
Sonogram depicting a combination of an intratesti...

Sonogram depicting a combination of an intratesticular and extratesticular right-sided varicocele.

Sonogram depicting a combination of an intratesti...Media file 9: Sonogram depicting a combination of an intratesticular and extratesticular right-sided varicocele.
Sonogram depicting a combination of an intratesti...

Sonogram depicting a combination of an intratesticular and extratesticular right-sided varicocele.

Sonogram depicting a combination of an intratesti...Media file 10: Sonogram depicting a combination of an intratesticular and extratesticular right-sided varicocele.
Sonogram depicting a combination of an intratesti...

Sonogram depicting a combination of an intratesticular and extratesticular right-sided varicocele.

Sonogram depicting a combination of an intratesti...Media file 11: Sonogram depicting a combination of an intratesticular and extratesticular right-sided varicocele.
Sonogram depicting a combination of an intratesti...

Sonogram depicting a combination of an intratesticular and extratesticular right-sided varicocele.

Sonogram depicting a combination of an intratesti...Media file 12: Sonogram depicting a combination of an intratesticular and extratesticular right-sided varicocele.
Sonogram depicting a combination of an intratesti...

Sonogram depicting a combination of an intratesticular and extratesticular right-sided varicocele.

Sonogram depicting a combination of an intratesti...Media file 13: Sonogram depicting a combination of an intratesticular and extratesticular right-sided varicocele.
Sonogram depicting a combination of an intratesti...

Sonogram depicting a combination of an intratesticular and extratesticular right-sided varicocele.

Sonogram depicting a combination of an intratesti...Media file 14: Sonogram depicting a combination of an intratesticular and extratesticular right-sided varicocele.
Sonogram depicting a combination of an intratesti...

Sonogram depicting a combination of an intratesticular and extratesticular right-sided varicocele.

Sonogram depicting a combination of an intratesti...Media file 15: Sonogram depicting a combination of an intratesticular and extratesticular right-sided varicocele.
Sonogram depicting a combination of an intratesti...

Sonogram depicting a combination of an intratesticular and extratesticular right-sided varicocele.

More on Varicocele

Overview: Varicocele
Imaging: Varicocele
Follow-up: Varicocele
Multimedia: Varicocele
References

References

  1. Lee J, Binsaleh S, Lo K, Jarvi K. Varicoceles: the diagnostic dilemma. J Androl. Mar-Apr 2008;29(2):143-6. [Medline][Full Text].

  2. Kumanov P, Robeva RN, Tomova A. Adolescent varicocele: who is at risk?. Pediatrics. Jan 2008;121(1):e53-7. [Medline][Full Text].

  3. Resim S, Cek M, Fazlioglu A, et al. Echo-colour Doppler ultrasonography in the diagnosis of varicocele. Int Urol Nephrol. 1999;31(3):371-82. [Medline].

  4. Tasçi AI, Resim S, Caskurlu T, et al. Color Doppler ultrasonography and spectral analysis of venous flow in diagnosis of varicocele. Eur Urol. Mar 2001;39(3):316-21. [Medline].

  5. Cornud F, Belin X, Amar E, et al. Varicocele: strategies in diagnosis and treatment. Eur Radiol. 1999;9(3):536-45. [Medline].

  6. Das KM, Prasad K, Szmigielski W, Noorani N. Intratesticular varicocele: evaluation using conventional and Doppler sonography. AJR Am J Roentgenol. Oct 1999;173(4):1079-83. [Medline][Full Text].

  7. McClure RD, Hricak H. Scrotal ultrasound in the infertile man: detection of subclinical unilateral and bilateral varicoceles. J Urol. Apr 1986;135(4):711-5. [Medline].

  8. Meyerson SL, Haider SA, Gupta N, et al. Abdominal aortic aneurysm with aorta-left renal vein fistula with left varicocele. J Vasc Surg. Apr 2000;31(4):802-5. [Medline].

  9. Sakamoto H, Ogawa Y, Yoshida H. Relationship between testicular volume and varicocele in patients with infertility. Urology. Jan 2008;71(1):104-9. [Medline].

  10. Sigmund G, Gall H, Bähren W. Stop-type and shunt-type varicoceles: venographic findings. Radiology. Apr 1987;163(1):105-10. [Medline][Full Text].

  11. Hamm B, Fobbe F, Sörensen R, Felsenberg D. Varicoceles: combined sonography and thermography in diagnosis and posttherapeutic evaluation. Radiology. Aug 1986;160(2):419-24. [Medline][Full Text].

  12. Dubin L, Amelar RD. Varicocele size and results of varicocelectomy in selected subfertile men with varicocele. Fertil Steril. Aug 1970;21(8):606-9. [Medline].

  13. Lund L, Hahn-Pedersen J, Hljhus J, Bojsen-Mlller F. Varicocele testis evaluated by CT-scanning. Scand J Urol Nephrol. Apr 1997;31(2):179-82. [Medline].

  14. von Heijne A. Recurrent varicocele. Demonstration by 3D phase-contrast MR angiography. Acta Radiol. Nov 1997;38(6):1020-2. [Medline].

  15. Paz A, Melloul M. Comparison of radionuclide scrotal blood-pool index versus gonadal venography in the diagnosis of varicocele. J Nucl Med. Jun 1998;39(6):1069-74. [Medline][Full Text].

  16. Gandini R, Konda D, Reale CA, et al. Male varicocele: transcatheter foam sclerotherapy with sodium tetradecyl sulfate--outcome in 244 patients. Radiology. Feb 2008;246(2):612-8. [Medline].

  17. Barrett J, Wells I, Riordan R, Roobottom C. Endovascular embolization of varicoceles: resorption of tungsten coils in the spermatic vein. Cardiovasc Intervent Radiol. Nov-Dec 2000;23(6):457-9. [Medline].

  18. Varma MK, Ho VB, Haggerty M, Bates DG, Moore DC. MR venography as a diagnostic tool in the assessment of recurrent varicocele in an adolescent. Pediatr Radiol. Aug 1998;28(8):636-7. [Medline].

  19. Zini A, Boman J, Baazeem A, Jarvi K, Libman J. Natural history of varicocele management in the era of intracytoplasmic sperm injection. Fertil Steril. Jan 25 2008;epub ahead of print. [Medline].

Further Reading

Keywords

varicocele, spermatic cord venous dilatation, spermatic cord vein dilatation, spermatic cord vein dilation, spermatic cord venous dilation, pampinocele, dilatation of veins of pampiniform plexus, varicosity of pampiniform plexus veins, incompetent valves of spermatic veins, bag of worms, absent valves of spermatic veins, male infertility, internal spermatic vein, pampiniform plexus, male infertility, scrotal swelling, scrotal pain

Contributor Information and Disclosures

Author

Ali Nawaz Khan, MBBS, FRCS, FRCP, FRCR, LRCP, Chairman of Medical Imaging, Professor of Radiology, NGHA, King Fahad National Guard Hospital, King Abdulaziz Medical City, Riyadh, Saudi Arabia
Ali Nawaz Khan, MBBS, FRCS, FRCP, FRCR, LRCP is a member of the following medical societies: American Institute of Ultrasound in Medicine, Royal College of Physicians, Royal College of Physicians and Surgeons of the United States, Royal College of Radiologists, and Royal College of Surgeons of England
Disclosure: Nothing to disclose.

Coauthor(s)

Sumaira MacDonald, MBChB, PhD, MRCP, FRCR, Lecturer, Sheffield University Medical School; Endovascular Fellow, Sheffield Vascular Institute
Sumaira MacDonald, MBChB, PhD, MRCP, FRCR is a member of the following medical societies: British Medical Association, Royal College of Physicians, and Royal College of Radiologists
Disclosure: Nothing to disclose.

Klaus L Irion, MD, PhD, Consulting Staff, The Cardiothoracic Centre Liverpool NHS Trust, The Royal Liverpool University Hospital, UK
Klaus L Irion, MD, PhD is a member of the following medical societies: American Roentgen Ray Society and Radiological Society of North America
Disclosure: Nothing to disclose.

Medical Editor

Harris L Cohen, MD, FACR, Vice Chairman/Associate Chairman (Research Activities), Director, Division of Body Imaging, Professor of Radiology, Stony Brook School of Medicine; Visiting Professor of Radiology, Johns Hopkins School of Medicine
Harris L Cohen, MD, FACR is a member of the following medical societies: American College of Radiology, American Institute of Ultrasound in Medicine, Association of Program Directors in Radiology, Radiological Society of North America, Society for Pediatric Radiology, and Society of Radiologists in Ultrasound
Disclosure: Nothing to disclose.

Pharmacy Editor

Bernard D Coombs, MB, ChB, PhD, Consulting Staff, Department of Specialist Rehabilitation Services, Hutt Valley District Health Board, New Zealand
Disclosure: Nothing to disclose.

Managing Editor

Joshua A Becker, MD, Professor, Department of Radiology, New York University School of Medicine
Joshua A Becker, MD is a member of the following medical societies: Society of Uroradiology
Disclosure: Nothing to disclose.

CME Editor

Robert M Krasny, MD, Consulting Staff, Department of Radiology, The Angeles Clinic and Research Institute
Robert M Krasny, MD is a member of the following medical societies: American Roentgen Ray Society and Radiological Society of North America
Disclosure: Nothing to disclose.

Chief Editor

Eugene C Lin, MD, Consulting Radiologist, Virginia Mason Medical Center; Clinical Assistant Professor of Radiology, University of Washington School of Medicine
Eugene C Lin, MD is a member of the following medical societies: American College of Nuclear Medicine, American College of Radiology, Radiological Society of North America, and Society of Nuclear Medicine
Disclosure: Nothing to disclose.

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.