questions 1

Varicocele

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Topic updated on 07/31/17 10:17am

Overview
 

 
Introduction
  • A 13-year-old boy presents to the urgent care clinic and reports pain in his scrotal area. He denies any rashes or inciting trauma. The pain is dull and does not radiate anywhere. On physical exam, there is a “bag of worms” on palpation of the left scrotum. The scrotum does not transilluminate with light.
Introduction
  • Clinical definition
    • varicose veins in the scrotum
  • Epidemiology
    • incidence
      • 15% in adult men
      • 8-20% in adolescent boys
      • most common cause of scrotal enlargement in adult males
    • demographics
      • around puberty in adolescents
    • location
      • most often on left side
        • due to increased resistance from left gonadal vein draining into left renal vein
  • Etiology
    • primary varicocele
      • venous reflux
    • secondary varicocele
      • renal cell carcinoma causing compression to the veins
  • Pathogenesis
    • increased venous pressure causing dilated veins in the pampiniform plexus
Presentation
  • Symptoms
    • primary symptoms
      • dull ache in scrotum
      • feeling of heaviness in scrotum
      • may be asymptomatic
      • infertility
      • atrophy
  • Physical exam
    • standing or valsalva maneuver
      • distension on inspection
      • “bag of worms” on palpation
    • illumination test with light
      • scrotum does not transilluminate
Imaging
  • Ultrasound with doppler
    • indications
      • if varicocele is suspected but physical exam is inconclusive
    • findings
      • dilatation of vessels of pampiniform plexus > 2 mm
      • reflux in pampiniform plexus
    • sensitivity and specificity
      • both 100%
Differential
  • Hydrocele      
    • positive transillumination test
  • Testicular torsion
    • abnormal cremasteric reflex
Treatment
  • Conservative
    • monitor with annual exams
      • indications
        • asymptomatic patients
        • no testicular hypotrophy
  • Operative
    • surgical ligation or embolization
      • indications
        • pain
        • infertility
        • delayed growth of testes
Complications
  • Infertility due to increased temperature
  • Testicular atrophy
 
 


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Qbank (1 Questions)

TAG
(M1.RP.31) A 27-year-old male presents with primary complaints of a palpable mass in his scrotum and mild testicular pain. Physical exam reveals an abnormal appearing scrotum around the left testis, as depicted in image A. Which of the following is the most likely etiology of this presentation? Topic Review Topic
FIGURES: A          

1. Compression of the left renal vein at the aortic origin of the superior mesenteric artery
2. Patent processus vaginalis allowing fluid entry into the scrotum
3. Neisseria gonorrhoeae Infection of the left testis leading to epididymitis
4. Unilateral failure of the left testis to descend into the scrotum
5. Twisting of the spermatic cord secondary to rotation of the left testis

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