Gray-scale and color Doppler sonographic findings in intratesticular varicocele

Purpose. We studied the gray-scale and color Doppler sonographic findings i n intratesticular varicoceles in 7 testes in 5 patients. Methods. The study group comprised 5 infertile men referred for scrotal son ography and found to have intratesticular varicocele. Patients were examine d at rest and during Valsalva's maneuver in supine and standing positions. A diagnosis of intratesticular varicocele was made when intratesticular vei ns 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 veno us dilatation (mediastinum testis versus subcapsular) were recorded. Results. Seven testes in 5 patients harbored visibly enlarged intratesticul ar veins that showed retrograde flow either spontaneously or during Valsalv a'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 di ameter in 3 testes and was 2.0 mm or larger in 4 testes. In all affected te stes, there was some degree of subcapsular venous dilatation, which in 3 te stes was even more prominent than venous dilatation in the mediastinum test is. All intratesticular varicoceles were accompanied by extratesticular var icoceles. Conclusions. 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 m m in diameter. Contrary to the previous descriptions of the entity, subcaps ular veins may be affected to a greater degree than mediastinal veins in in tratesticular varicocele. (C) 2001 John Wiley & Sons, Inc.