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Intratesticular Varicocele

An Easy Diagnosis But Unclear Physiopathologic Characteristics

Department of Urinary and Vascular Radiology, Hospices Civils de Lyon, Hôpital Edouard Herriot, Lyon, F-69437, France. (R.T., P.J., D.L., O.R.); Faculty of Medicine, Université de Lyon, Lyon, F-69003, France; Université de Lyon 1, Faculté de Médecine Lyon Nord, Lyon, F-69003, France (D.L., O.R.); and Inserm U556, Lyon, F-69424, France (D.L., O.R.).

Address correspondence to Olivier Rouvière, MD, PhD, Department of Genitourinary Radiology, Hôpital Edouard Herriot, Place d’Arsonval, Pavilion P, 69003 Lyon France. E-mail: olivier.rouviere{at}netcourrier.com

Objective. Intratesticular varicocele (ITV) is an uncommon sonographic finding with controversial data concerning its prevalence and physiopathologic characteristics. The goal of this study was to determine the prevalence of ITV in a urogenital imaging department and to describe its sonographic features. Methods. All identified cases of ITV were prospectively collected in the same imaging department. Results. Intratesticular dilated veins (>2 mm) with a positive response to the Valsalva maneuver were referred to as ITV. Nine cases of ITV were detected in 8 patients (mean age, 60 years; range, 30–85 years) in a series of 1832 scrotal sonographic examinations performed over 5 years (0.4%). A history of homolateral scrotal surgery was found in 5 cases. In most cases, ITV was left sided (6/9) and located in the mediastinum testis (6/9) with associated extratesticular varicocele (8/9) and testicular hypotrophy (7/9). Five of the 7 hypotrophic testes had other causes of hypotrophy. Conclusions. Although variations do exist in the sonographic appearance of ITV, its specific sonographic and Doppler appearance should enable the radiologist to obviate further study. Intratesticular varicocele is often associated with ipsilateral testicular atrophy, but whether it is a cause or a consequence of testicular atrophy remains unclear.

Key Words: sonography • testicular diseases • varicocele

Abbreviations: ETV, extratesticular varicocele • ITV, intratesticular varicocele • MRI, magnetic resonance imaging