Pediatric Varicocele

  • Etiology: Dilatation of the pampiniform venous plexus found in spermatic cord
  • Imaging US:
    — Collection of enlarged veins greater than 3 millimeters in diameter which characteristically have serpiginous appearance and have increased US Color Doppler flow on Valsalva maneuver
    — Almost always left sided
  • DDX:
  • Complications: Infertility
  • Treatment: Embolization or surgical ligation of testicular vein
  • Note: Unilateral right-sided varicocele is uncommon and if present should prompt evaluation of retroperitoneum to exclude a mass obstructing the downstream testicular vein
  • Clinical:
    — Most frequently encountered mass in spermatic cord
    — Can present as scrotal mass or scrotal pain
    — Seen in 10-15% of adolescents

Radiology Cases of Varicocele

US of varicocele
Sagittal greyscale US of the left scrotum (upper left) shows a serpiginous appearing mass in the superior aspect of the scrotum which during a Valsalva maneuver (upper right) increases in size. Sagittal color US of the left scrotum (lower left) shows the mass to be composed of blood vessels that have increasing venous flow seen through them during a Valsalva maneuver (lower right).
US of varicocele
Transverse US of the left scrotum (above) shows a collection of enlarged serpiginous appearing veins superior to the testicle which are greater than 3 millimeters in diameter and which on transverse US of the left scrotum during a Valsalva maneuver (below) increase in diameter.
US of pediatric varicocele
Transverse grayscale (above left) and transverse color doppler (above right) US of the upper left scrotum obtained without Valsalva show dilated tubular structures that are venous in nature. Transverse grayscale (below left) and transverse color doppler (below right) US of the upper left scrotum obtained with Valsalva show the dilated tubular structures to increase in diameter and venous flow with Valsalva.