Case discussion
01Clinical context
A scrotal ultrasound was performed to evaluate suspected varicocele. Both testes and pampiniform plexuses were assessed with grayscale and Doppler techniques in different positions including Valsalva maneuver.
02Key imaging findings
Both testes are normal in size, shape, and echotexture with symmetric vascularity and no focal lesions. The right pampiniform plexus shows dilated veins up to 4.4 mm with minimal reflux on Valsalva, consistent with Grade III varicocele. The left pampiniform plexus shows mild prominence with veins measuring 2.9–3.1 mm, no significant reflux, consistent with mild Grade I–II varicocele. No hydrocele is present.
03Diagnostic reasoning
High-resolution scrotal ultrasound was performed using grayscale and color Doppler imaging. Both testes and epididymides were evaluated for size, echotexture, and focal lesions. The pampiniform plexuses were assessed bilaterally in supine and standing positions, including dynamic evaluation during Valsalva maneuver to detect venous reflux and measure vein diameters. The combination of positional changes and Doppler reflux assessment allowed accurate grading of varicocele severity.
04Questions for clinical practice
What is the clinical significance of Grade III varicocele? Grade III varicocele is hemodynamically significant and may warrant urological referral for management. How does Valsalva maneuver aid diagnosis? It increases intra-abdominal pressure, enhancing venous reflux detection. When should follow-up imaging be considered? Follow-up depends on symptoms and treatment; asymptomatic mild varicocele may not require immediate re-imaging. Does absence of hydrocele affect management? No hydrocele suggests no associated fluid collection, simplifying clinical decisions.
05Teaching point
Ultrasound with Doppler in supine and standing positions plus Valsalva maneuver is essential for accurate grading of varicocele. Right-sided Grade III varicocele shows dilated veins with reflux, while mild left-sided varicocele lacks significant reflux, guiding clinical management.
Shown for education. De-identified — no identifiable patient data. A radiology report is a specialist opinion and must be read with the full clinical context by the treating physician.