35 year old man presents during workup for infertility.

Varicocele

• Varicoceles represent dilated veins of the pampiniform plexus. They result from incompetent or absent valves in the spermatic vein. Varicoceles occur in 15% of adult males
• Clinical Findings: Infertility, pain, scrotal enlargement. Most men are asymptomatic, however. Nearly 50% of men evaluated for infertility are diagnosed with unilateral or bilateral varicoceles
• Location: 90% of all varicoceles occur on the left side (drainage of the left spermatic vein into the left renal vein at a right angle). 25% of varicoceles are bilateral. A solitary right side vaicocele requires the exclusion of an underlying malignancy causing obstruction
• US findings: Hypoechoic veins (“bag of worms”), Veins >2mm diamtere, dilated veins easily compressed by transducer, increase in venous size when patient is upright of Valsalva performed, color flow seen within veins on Doppler and color increases with Valsalva
• Treatment: Surgical ligation or embolotherapy

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