A varicocele is a collection of venous varicosities in the spermatic veins in the scrotum. This is caused by imcomplete drainage for the pampiniform plexus. This may be seen is up 20% of males and is asymptomatic most of the time. Most are found on the left side.
Why should you care, you might ask? Well, the right spermatic vein drains into the IVC and then into the renal vein, whereas the left spermatic vein drain drains directly into the renal vein.
In the patient with new onset, unilateral varicocele, consider an IVC thrombus/tumor if right sided and a left renal clot if left sided.
A case we had recently was a 30 yo male with nephrotic syndrome (a HUGE risk factor for renal vein thrombosis) who presented with left-sided scrotal swelling. He was found to have a left-sided varicocele. Based on this finding, a renal sono was performed and the diagnosis of left renal vein thrombosis was made.
References
1. Junnila J, Lassen P. Testicular masses. Am Fam Physician 1998;57:685-92
