Intratesticular Varicocele

Abstract

Objective. The purpose of this study was to evaluate the gray scale and color Doppler appearances of intratesticular varicocele (ITV) in a relatively large series of men and to compare the findings with those previously reported. Methods. Fifteen ITVs found in 12 men referred for sonographic examination of a variety of scrotal conditions were retrospectively evaluated. Review of the side, location, shape, and diameter of the dilated veins, the presence of an extratesticular varicocele (ETV), and the color Doppler appearance of the ITV before and during the Valsalva maneuver was performed. Results. Seven (47%) of 15 ITVs were located in the left testis, 2 (13%) in the right, and 3 (20%) bilateral. Eighty-six percent of the ITVs were associated with an ipsilateral ETV. The locations of the ITVs were subcapsular in 60% of the cases and within or near the mediastinum of the testis in 40%. The shapes of the ITVs were tubular in 46%, oval in 27%, and both tubular and oval in the remaining 27%. Color Doppler imaging showed spontaneous flow in 60% of cases, whereas in the remaining 40%, the blood flow could be seen only after the Valsalva maneuver. Conclusions. Intratesticular varicocele is a rare condition with a variable clinical and sonographic appearance. It is usually associated with ETV. It occurs in the left, right, or both testes and may be subcapsular or mediastinal in location. The prevalence of a subcapsular location of ITVs in this series was by far higher than previously mentioned in the literature. The Valsalva maneuver plays a very important role in the diagnosis of ITV because in almost half of cases, the flow will not show up spontaneously. 2-14 It has been defined sonographically as tubular or oval structures with a diameter of 2 mm or greater in and around the mediastinum testis with venous flow and a positive Valsalva maneuver response. 9 The clinical importance of this condition has not been established yet, but awareness of its appearance on sonography is important to differentiate it from other focal testicular lesions, including malignancy.The aim of this study was to describe the gray scale and color Doppler appearances in a relatively large series of men with ITVs and to compare the findings with those previously reported.

Intratesticular varicocele

“…On color Doppler imaging flow can be spontaneous or flow could be seen only after the Valsalva manoeuvre. [4] The Valsalva manoeuvre plays a very important role in the diagnosis of intratesticular varicoceles because in almost half of cases, the flow will not show up spontaneously. [5] Intratesticular varicoceles can be tubular or oval in shape.…”

The Rare, the Odd, and the Atypical

“…They are almost always associated with an extratesticular varicocele. Most patients will present with infertility or pain, the latter of which is thought to be secondary to the stretching of the tunica albuginea with dilation of the veins 27 …”

“…12A). In 50% of patients, the intratesticular veins will fill with color when interrogated with color Doppler 27 (Fig. 12B).…”

“…Most patients will present with infertility or pain, the latter of which is thought to be secondary to the stretching of the tunica albuginea with dilation of the veins. 27 The classic US finding is an anechoic serpiginous tubular structure extending from the mediastinum testis to the periphery (Fig. 12A).…”