Put your best ball forward: The rare occurrence of varicocele thrombosis
Ciara O'Toole Hutchison, University College Dublin
Background
Varicocele thrombosis is an exceptionally rare cause of acute scrotal pain. A varicocele is described as an irregularly dilated and painful pampiniform venous plexus within the spermatic cord. This rare pathology can be often misdiagnosed on clinical examination due to the non-specific presentation and comparable similarities to other inguinal conditions. This case describes the role of ultrasound in diagnosing varicocele thrombosis in two male patients, aged 39 and 24 years old respectively. Both patients were referred for an urgent testicular ultrasound examination.
Ultrasound findings
B-mode and colour Doppler ultrasound demonstrated hypoechoic tubular structures in the epididymal body and tail. A moderately sized varicocele was detected on the left testicle in both patients, combined with a segment of echogenic material suggestive of a thrombosed varicocele.
Discussion
Varicocele thrombosis is rare and can be difficult to diagnose on clinical examination. Ultrasound is considered the modality of choice for first-line investigation. Doppler ultrasound confirmed the diagnosis of the left thrombosed varicocele, showing a complete absence of blood flow within a short venous segment in the varicocele, confirmed during the Valsalva technique. Currently, there is no standardised treatment option for varicocele thrombosis and further research is recommended. Conservative treatment is recommended to treat the majority of patients due to the risks of post-surgical complications. However, surgical intervention and embolisation are considered in patients who are frequently diagnosed with varicoceles where the risk of infertility is high.
Conclusion
Ultrasound plays an essential role in the diagnosis of varicocele thrombosis. It is regularly deemed superior to a physical examination in detecting varicocele thrombosis. Ultrasound is a preferred imaging technique as it is readily available, non-ionising and non-intrusive, all lending to the patients’ age and allowing for a prompt diagnosis and reducing the impact of further complications.