Dilatation of pampiniform plexus > 2-3 mm due to congestion and retrograde flow in internal spermatic vein

Dilated serpiginous veins at superior pole of testis

“Flash” of color Doppler with Valsalva

Left (78%), right (6%), bilateral (16%)

Varicose veins > 2-3 mm diameter, increase in size with Valsalva

Primary: Incompetent venous valve near junction of left renal vein (LRV) and IVC

Secondary: Obstruction of LRV by renal or adrenal tumor, nodes or rarely SMA compression

Most frequent cause of male infertility

Vague scrotal discomfort or pressure when standing

10-15% of men in USA have varicoceles

Subclinical varicocele in 40-75% of infertile men

Catheter embolization, surgical treatment, or sclerotherapy if symptomatic

Emerging research suggests even subclinical varicoceles should be treated

Consider left renal vein occlusion by tumor in elderly male patient presenting with recent onset of varicocele

Varicocele diagnosed when vessel > 2 mm during quiet respiration in supine position

Unilateral and left-sided varicoceles common; isolated right-sided varicoceles uncommon and should prompt evaluation along IVC to exclude mass

Valsalva with color Doppler essential for diagnosis of small varicoceles

Measure diameter of vein on grayscale; blooming artifact on color Doppler will obscure true diameter and lead to overestimation of diameter

Measure vein from inner wall to inner wall

Avoid mistaking vas deferens as dilated vein

Varicoceles usually lie superior to testicle but may lie posterior or lateral to testicle