questions 2

Varicocele

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Topic updated on 09/26/16 3:22pm

Snapshot
  • A 54 year-old man present with a mass in his scrotum. It feels like it is filled with worms.
Introduction
  • Varicose veins in testicle due to failure of vain valves
  • Varicoceles are a relatively common condition
    • (affecting approximately 10 percent of men)
  • Occur in young men, usually during the second or third decade of life.
Presentation
  • May be asymptomatic
  • Symptoms
    • pain
    • atrophy (shrinkage) 
    • fertility problems
  • Right-sided or bilateral varicocele as well as varicocele that fails to disappear upon lying supine raises concern for IVC obstruction
    • A CT abdomen with contrast is warranted in these cases for potential detection of IVC thrombosis or compression
Treatment
  • Surgery
  • Varicocele embolization


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(M3.RL.6) A 28-year-old male presents to a urologist upon referral from a fertility medicine specialist who evaluated the patient and his wife. The patient was told that he had a low sperm count with 'poor quality' sperm. Examination reveals a scrotum that, on the right side only, is enlarged and feels like a 'bag of worms' on palpation. Additionally, the examination reveals right testicular atrophy. When the patient lies supine, there is no change in the appearance or size of the scrotum. An ultrasound and color Doppler study of the patient's right testicle is shown in Figure A. Which of the following is the best next step in the management or evaluation of this patient's presentation? Topic Review Topic
FIGURES: A          

1. Observation with no further testing or management
2. MRI pelvis
3. CT abdomen
4. Embolization
5. Surgical repair

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