A 58-year-old man presents with a newly noticed left scrotal swelling described as a bag of worms that does not disappear on lying down. It appeared over two months without any strain or heavy exertion. What is the most appropriate next investigation?

• A Semen analysis
• B Scrotal Doppler ultrasound alone
• C Serum follicle stimulating hormone
• D CT scan of abdomen and pelvis ✓

Explanation

A right-sided varicocele, or a new-onset left varicocele in an older man that does not decompress when recumbent, suggests secondary varicocele due to compression of the left renal vein by a tumour. Renal cell carcinoma invading the renal vein is the classic cause. Abdominal CT is therefore mandatory to exclude a renal mass. Semen analysis assesses fertility impact but misses the underlying malignancy, and scrotal ultrasound confirms the varicocele but never evaluates the retroperitoneum.

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.