A 58-year-old man presents with a newly noticed right-sided varicocele that appeared over three months. He reports mild loin discomfort and weight loss. What is the most likely underlying cause?
- A Left renal vein compression between the aorta and superior mesenteric artery
- B Incompetent cremasteric venous plexus valves
- C Right renal cell carcinoma with tumour thrombus in the inferior vena cava ✓
- D Retroperitoneal fibrosis limited to the left ureter
Correct answer: C. Right renal cell carcinoma with tumour thrombus in the inferior vena cava
Explanation
A new right-sided varicocele in an adult is a red flag for an intra-abdominal or retroperitoneal malignancy obstructing the right spermatic vein, classically right renal cell carcinoma extending into the inferior vena cava. Left varicoceles are far commoner and usually idiopathic, attributed to the perpendicular entry of the left spermatic vein into the left renal vein. Nutcracker compression explains left-sided, not right-sided, varicocele.
Reference: Bailey and Love's Short Practice of Surgery, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.