A 22-year-old man complains of a dull dragging pain in the left scrotum that worsens towards the end of the day and improves on lying down. On examination, standing, there is a soft tortuous mass above the left testis described as a bag of worms, which disappears when he lies supine. The testes are normal in size bilaterally. What is the diagnosis?
- A Encysted hydrocele of the cord
- B Left varicocele ✓
- C Indirect inguino-scrotal hernia
- D Epididymal cyst
Correct answer: B. Left varicocele
Explanation
Varicocele is an abnormal dilation of the pampiniform venous plexus, commonest on the left because the left testicular vein drains at a right angle into the left renal vein. It feels like a bag of worms, is more prominent standing, and empties on recumbency, a feature that distinguishes it from a hernia, which does not reliably disappear, and from an epididymal cyst, which is separate from the cord above the testis.
Reference: Bailey and Love's Short Practice of Surgery, 28th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.