Imaging the Infertile Male -1: Varicocele

Color Doppler ultrasound is the imaging modality of choice to evaluate patients with varicocele. In order to assess correctly the extension of the disease and the characteristics of flow, the patient should be examined supine and while standing, at rest and during Valsalva’s maneuver. Several classifications can be used to grade varicocele based on position of the dilated vessels and characteristics of flow. Besides color Doppler ultrasound, spectral analysis is important to assess reflux duration. Experimental studies showed that varicocele causes flow changes in the testicular flows, but investigation in men requires validation. While extratesticular varicocele is relatively common, intratesticular varicocele is rare. Abdominal masses may not cause compressible secondary varicocele. CT and MR imaging are usually not indicated for evaluation of varicocele, but this condition may be recognized in case of examinations performed for other purposes. Scintigraphy and thermography have no current clinical role, while venography is usually performed as a part of percutaneous sclerotherapy.