Case history
Case history #1
A 15-year-old boy presents with a left scrotal swelling/mass. The patient states that he is completely asymptomatic. There is no significant medical history and he has not had any previous surgeries. He takes no medications and has no allergies. Physical exam in the supine position reveals asymmetric testicular size (left smaller than right) with no masses. With the patient in the standing position, a grade III left varicocele can clearly be seen and palpated in the left hemiscrotum.
Case history #2
A 30-year-old healthy man presents with primary infertility. He has been unable to establish a pregnancy for the last 12 months with his partner. On physical exam, a grade II left varicocele is easily palpable when the patient is standing and is nonpalpable when supine. The testicles are symmetric and normal in size.
Other presentations
Approximately 3% of adolescent boys will present with dull pain or aching in the affected testis/groin.[2] Adult varicoceles may be discovered during evaluation for male infertility, hypogonadism, scrotal discomfort, scrotal mass, or testicular atrophy. A pathognomonic feature of a large grade III varicocele is a "bag of worms" appearance of the scrotum, where a mass of dilated veins is easily visible through the thin scrotal wall.
Adult men presenting for evaluation of low testosterone and related symptoms may also be found to have a varicocele. Varicocele has been increasingly recognized as an uncommon cause of decreased testosterone production in men for whom fertility is not a concern.[1]
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