Gray-scale and color Doppler sonographic findings in intratesticular varicocele

We studied the gray-scale and color Doppler sonographic findings in intratesticular varicoceles in 7 testes in 5 patients.

The study group comprised 5 infertile men referred for scrotal sonography and found to have intratesticular varicocele. Patients were examined at rest and during Valsalva's maneuver in supine and standing positions. A diagnosis of intratesticular varicocele was made when intratesticular veins visible on gray-scale sonography showed retrograde flow on color Doppler sonography either spontaneously or during Valsalva's maneuver. The maximum diameter of dilated intratesticular veins and the predominant site of venous dilatation (mediastinum testis versus subcapsular) were recorded.

Seven testes in 5 patients harbored visibly enlarged intratesticular veins that showed retrograde flow either spontaneously or during Valsalva's maneuver. The condition was bilateral in 2 patients and left-sided in 3 patients. The largest intratesticular vein measured less than 2.0 mm in diameter in 3 testes and was 2.0 mm or larger in 4 testes. In all affected testes, there was some degree of subcapsular venous dilatation, which in 3 testes was even more prominent than venous dilatation in the mediastinum testis. All intratesticular varicoceles were accompanied by extratesticular varicoceles.

A threshold value of 2.0 mm seems inadequate for the diagnosis of intratesticular varicocele because obviously variceal venous structures with retrograde flow on color Doppler sonography may be smaller than 2.0 mm in diameter. Contrary to the previous descriptions of the entity, subcapsular veins may be affected to a greater degree than mediastinal veins in intratesticular varicocele.