A 62-year-old man presents with a newly noticed left scrotal swelling. Examination reveals a left varicocele that does not decompress when he lies supine. He has no urinary symptoms and examination of the testis is otherwise normal.

• A Contrast-enhanced CT of abdomen and pelvis ✓
• B Colour Doppler scrotal ultrasonography
• C Semen analysis
• D Left renal venography

Explanation

B new-onset left varicocele in an older man that fails to empty in the recumbent position suggests a secondary varicocele from obstruction of the left renal vein, classically by a renal cell carcinoma tumour thrombus. The right testicular vein drains directly into the IVC, so right-sided lesions are far less likely. The first step is cross-sectional imaging of the abdomen, and contrast CT is the standard choice. Scrotal Doppler only confirms the varicocele itself and will not identify the cause.

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.