A 58-year-old man notices a new left scrotal swelling that increases on standing and reduces on lying down; examination shows a bag-of-worms feel above the testis. He has never had this before. What is the most appropriate next step?
- A Reassurance with scrotal support, as varicocele is benign
- B CT scan of abdomen and pelvis to exclude a left renal tumour ✓
- C Testicular biopsy to exclude intratesticular pathology
- D Urine culture and empirical antibiotics
Correct answer: B. CT scan of abdomen and pelvis to exclude a left renal tumour
Explanation
An acute or new-onset left varicocele in an adult over 40 is a red flag for a left renal cell carcinoma invading the left renal vein, obstructing the gonadal vein which drains at a right angle into it. Contrast CT of the abdomen and pelvis is indicated before any varicocele surgery. Reassurance is wrong because a long-standing varicocele in a young man is the benign setting, not a new one in this age group.
Reference: Bailey and Love's Short Practice of Surgery, 27th ed.
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Written and medically reviewed by the StethoPrep medical team.