Varicocele

[Linh]

Dear Steve,

What is your criteria for diagnosing varicocele?

Sometimes when I measure the AP diameter of the vessel to be 3-4mm, but on Valsalva, there isn’t a ‘can of worms’ appearance in Colour Doppler. What is your protocol? Do you do a trace?

Best regards,
Linh

[Stephen Bird]

Hi Linh,

I use 4mm as my diameter and yes, I do perform valsalva with the colour Doppler on the pampiniform plexus veins.
I don’t use pulse Doppler.
I also don’t call it a varicocele if there is just a single vein lurking in the left hemiscrotum. For me there has to be a “nest” of vessels in the scrotum to call it a varicocele. The veins should not just be in the lower hemiscrotum adjacent to the epididymal tail , but should extend along the length of the testicle .

These are my personal thoughts and using these criteria prevents me from over-calling normal pam-uniform plexus veins , particularly in the left hemiscrotum as a “varicocele”

There is some literature that advocated strict measurement criteria as well as supine and erect scanning, however I have not adopted this in my clinical practice.

Steve

[Linh]

I am also reluctant to call it until I see that nest of vessels really light up the screen on Colour Doppler. Thanks for sharing your view Steve.

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