The Common Vein

Ultrasound

A varicocele, defined as a pathological enlargement of the pampiniform plexus with veins often running in a winding course,

The incidence of varicocele in males with primary (35%) and secondary (80%) infertility is significantly higher compared to the general male population (15%)

 

The etiology of varicocele is multifactorial. Differences in the course of testicular veins are considered to underlie the higher incidence of left-sided varicocele (>80% of cases). The left testicular vein runs vertically and enters the left renal vein at a right angle, which predisposes to turbulent blood flow and reverse pressure, while the right testicular vein opens directly into the inferior vena cava at a sharp angle^(6, 7).

Compression of the left renal or testicular vein, either as a result of the so-called nutcracker mechanism or due to renal or retroperi-toneal tumors, is a relatively rare cause of varicocele^(6, 11). A sudden onset of varicocele in a man over the age of 30 years requires the exclusion of renal tumors, particularly in elderly patients. In such cases it is necessary to extend diagnostic ultrasonography with abdominal examination.

• dilatation of pampiniform plexus veins >2-3 mm in diameter ³
• characteristically have a serpiginous appearance
• there can be flow reversal with the Valsalva maneuver ⁴
• Doppler ultrasound can be used to grade the degree of reflux

 

Links and References

Lorenc T et al Ultrasound and Varicocele