A 24-year-old man with a left scrotal swelling and dull ache undergoes scrotal ultrasound. Supine images show dilated serpiginous veins in the pampiniform plexus posterior to the left testis, which increase in calibre and show reversed flow on colour Doppler during Valsalva manoeuvre. Which finding threshold supports the diagnosis of a significant varicocele?

• A Pampiniform vein diameter less than 2 mm with continuous forward flow
• B Pampiniform vein diameter greater than 3 mm with Valsalva-induced flow reversal ✓
• C Testicular volume asymmetry alone without venous dilatation
• D Reactive hydrocele surrounding the epididymis

Explanation

Varicocele is diagnosed when pampiniform plexus veins exceed approximately 3 mm in diameter and demonstrate venous dilatation with retrograde or reversed flow on Valsalva, reflecting incompetent valves in the internal spermatic vein. It is left sided in over 90 percent of cases because the left spermatic vein drains perpendicularly into the left renal vein. B new right sided varicocele in an older man should prompt imaging to exclude a renal or retroperitoneal malignancy obstructing the vein.

Reference: Rumack's Diagnostic Ultrasound, 5th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.