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: www.bostonimaging.com/rs85-pr...
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[@deanwellmer3668]

Outstanding presentation. Thank you so much !!!!

[@Radquarters]

Thank you for the feedback, and glad you liked it!

[@samradalpha]

Amazing images and great presentation.

[@Radquarters]

Thank you, appreciate that!

[@samradalpha]

Always look forward for your next UA-cam video.

[@Radquarters]

I appreciate that! More to come :)

[@angbahope2762]

Great delivery 💪

[@Radquarters]

Thank you!

[@AkhtarAli-or3zx]

Very nice explanation thanks, what is the treatment of varices in grade 2 and 3

[@sampathkumarv7605]

very nice

[@Radquarters]

Thank you! Appreciate that

[@azharsyed1867]

Thanks

[@Radquarters]

You're welcome.

[@user-ot1kh6lx9i]

Thank you for this lecture

[@Radquarters]

You are most welcome

[@user-iv9uq8kj9r]

Please how many types or grades do we have interms of ultrasoun ? Please send me the answer

[@K.A.K.A._7676]

Is red colour indication is swollen vein

[@venkatkishan2372]

Can you explain the role of ultrasound in subclinical varicocele
All the cases you have shown might have been obvious with clinical palpation as the diameter were well above 3 mm
What about those cases of subclinical varicocele - that is those cases which are not palpable as bag of worms but patient referred for ultrasound due to infertility

[@Radquarters]

Good question. Technically, a vein measuring 2 mm or more is considered a varicocele and can be well seen by ultrasound, even if considered subclinical (i.e., non-palpable with Valsalva). However, most urologists I work with won't typically consider treatment until varicocele reaches a diameter of 3 mm. Also, location of the varicocele is relevant for grading, meaning a varicocele at the spermatic cord is usually less significant than dilated pampiniform veins in the lower scrotal sac, as well as the duration of regurgitation during Valsalva. Great reference article by Lorenc et al: www.ncbi.nlm.nih.gov/pmc/articles/PMC5269523/

[@rahaafzaly4149]

According to the size of the vein in millimeters, how many degrees of varicocele do we have? Please send me the answer

[@Radquarters]

Unfortunately, there are multiple grading systems for varicocele, and some of them conflict. Location of the varicocele and degree of reflux with color Doppler are typically used for grading as opposed to just vein diameter. For example, varicocele only at the spermatic cord with reflux with Valsalva is considered lower grade than varicocele in the lower scrotum showing spontaneous reflux.

[@BudgetGainsByJJ]

@@Radquarterswhen I did my ultrasound I was diagnosed with a sub clinical varicocele. I was taking Gingko biloba at the time which dilates your veins, I was also bodybuilding around this time. About a year later I went to a very well known urologist in Australia and he examined my testicle carefully and he was very convinced that I didn’t have a varicocele but he did say that ultrasounds make veins appear “bigger than what they are”.
My question by what I’ve said: could I been misdiagnosed? At the time I checked my sperm count and I was actually above the high range and my doctor was amazed by it, so nothing affected fertility. Only thing I was diagnosed with was a tight pelvic floor, could that also temporarily enlarge veins? Thanks

[@jacoblas1371]

Hi
Should testes ultrasound be conducted with the patient standing or supine?
I had a physical examination and my GP suspects varicocele, but my testes ultrasound showed no varicocele.

[@Radquarters]

Scrotal ultrasounds are usually performed in supine position, but for varicocele the standing position is sometimes added.

[@Muhammad_Raian]

Ultrasound while lying can identify varicocele?

[@Radquarters]

Yes, particularly if Valsalva is used, but standing position often helps with diagnosis.

[@prosantabarikder978]

ওকে বশ

[@kujtimalimeri3634]

Frence

[@AkhtarAli-or3zx]

Sorry varicocele