A 20-year-old man complains of a dull scrotal ache that worsens towards evening and after standing all day. Examination reveals a soft scrotal swelling described as a bag of worms, which reduces on lying down. The anatomical reason it occurs far more commonly on the left side is:
- A The left testicular vein drains into the inferior vena cava directly
- B The left testicular vein enters the left renal vein almost at a right angle ✓
- C The left cremasteric pump is intrinsically weaker
- D The left testis hangs higher than the right
Correct answer: B. The left testicular vein enters the left renal vein almost at a right angle
Explanation
The left internal spermatic vein joins the left renal vein at close to a right angle, creating a column of blood subject to higher pressure, whereas the right vein drains obliquely into the inferior vena cava. The left vein is also longer and may be compressed by the superior mesenteric artery against the aorta (nutcracker effect), explaining the left-sided predominance. Option A describes the venous drainage of the right side, so it is factually wrong. Sudden-onset or isolated right-sided varicocele in an adult should raise suspicion of a renal tumour compressing the vein.
Reference: Gray's Anatomy for Students, 4th ed.
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Written and medically reviewed by the StethoPrep medical team.