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Left renal vein compression as cause for varicocele: prevalence and associated findings on contrast-enhanced CT

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Abstract

Purpose

The purpose of this study is to determine the prevalence of left renal vein compression in patients with varicoceles.

Methods

Abdominal and pelvis contrast-enhanced CT images from 100 male patients with varicoceles (mean age 50.6 years) and 100 matched control patients (mean age 49.8 years) were retrospectively reviewed. The diameter of the left renal vein was measured as it crosses between the aorta and superior mesenteric artery and was classified as compressed if there was greater than 50% narrowing. The diameter of the left gonadal vein was measured at the origin. Comparison of the prevalence of left renal vein compression was made via a Chi-squared test and the gonadal vein diameter via a t test.

Results

The distribution of varicoceles was 68 on the left, 24 bilateral, and 8 on the right. Compression of the left renal vein was significantly more common in the left varicocele (78%, 53/68) than in the bilateral varicocele (42%, 10/24, p = 0.002), right varicocele (13%, 1/8, p < 0.001), or control group (10%, 10/100, p < 0.001). In the subgroup analysis, the gonadal vein diameter was significantly greater in the left varicocele (mean 5.6 mm) than in the bilateral varicocele (mean 4.6 mm, p = 0.018), right varicocele (mean 3.2 mm, p < 0.001), and control group (mean 3.1 mm, p < 0.001).

Conclusion

Left renal vein compression by the superior mesenteric artery is a major contributor to left-sided varicoceles.

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References

  1. World Health Organization (1992) The influence of varicocele on parameters of fertility in a large group of men presenting to infertility clinics. Fertil Steril 57:1289–1293

    Google Scholar 

  2. Sandlow J (2004) Pathogenesis and treatment of varicoceles. Bmj 328:967–968.

    Article  PubMed Central  PubMed  Google Scholar 

  3. Skoog SJ, Roberts KP, Goldstein M, Pryor JL (1997) The adolescent varicocele: what’s new with an old problem in young patients? Pediatrics 100:112–121.

    Article  CAS  PubMed  Google Scholar 

  4. Fretz PC, Sandlow JI (2002) Varicocele: current concepts in pathophysiology, diagnosis, and treatment. Urol Clin North Am 29:921–937.

    Article  PubMed  Google Scholar 

  5. Richardson I, Grotas AB, Nagler HM (2008) Outcomes of varicocelectomy treatment: an updated critical analysis. Urol Clin North Am 35:191–209 ((viii)).

    Article  PubMed  Google Scholar 

  6. Wishahi MM (1991) Anatomy of the venous drainage of the human testis: testicular vein cast, microdissection and radiographic demonstration. A new anatomical concept. Eur Urol 20:154–160.

    CAS  PubMed  Google Scholar 

  7. Chait A, Matasar KW, Fabian CE, Mellins HZ (1971) Vascular impressions on the ureters. Am J Roentgenol Radium Ther Nucl Med 111:729–749.

    Article  CAS  PubMed  Google Scholar 

  8. Ahlberg NE, Bartley O, Chidekel N, Fritjofsson A (1966) Phlebography in varicocele scroti. Acta Radiol Diagn (Stockh) 4:517–528

    CAS  Google Scholar 

  9. Braedel HU, Steffens J, Ziegler M, Polsky MS, Platt ML (1994) A possible ontogenic etiology for idiopathic left varicocele. J Urol 151:62–66.

    CAS  PubMed  Google Scholar 

  10. Shafik A, Moftah A, Olfat S, Mohi-el-Din M, el-Sayed A (1990) Testicular veins: anatomy and role in varicocelogenesis and other pathologic conditions. Urology 35:175–182.

    Article  CAS  PubMed  Google Scholar 

  11. Grimm LJ, Engstrom BI, Nelson RC, Kim CY (2013) Incidental detection of nutcracker phenomenon on multidetector CT in an asymptomatic population: prevalence and associated findings. J Comput Assist Tomogr 37:415–418.

    Article  PubMed  Google Scholar 

  12. Kurklinsky AK, Rooke TW (2010) Nutcracker phenomenon and nutcracker syndrome. Mayo Clin Proc 85:552–559.

    Article  PubMed Central  PubMed  Google Scholar 

  13. Liebl R (2009) Nutcracker phenomenon or nutcracker syndrome? Nephrol Dial Transpl 20 (author reply 2009. Epub 2005 Jun 2028).

  14. Buschi AJ, Harrison RB, Norman A, et al. (1980) Distended left renal vein: CT/sonographic normal variant. AJR Am J Roentgenol 135:339–342.

    Article  CAS  PubMed  Google Scholar 

  15. Vassilev I (1962) Radiographic study of the left spermatic vein in the course of idiopathic varicoceles. Press Med 70:704.

    CAS  PubMed  Google Scholar 

  16. Saypol DC, Howards SS, Turner TT, Miller ED Jr. (1981) Influence of surgically induced varicocele on testicular blood flow, temperature, and histology in adult rats and dogs. J Clin Invest 68:39–45.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  17. Zerhouni EA, Siegelman SS, Walsh PC, White RI (1980) Elevated pressure in the left renal vein in patients with varicocele: preliminary observations. J Urol 123:512–513.

    CAS  PubMed  Google Scholar 

  18. Eliahou R, Sosna J, Bloom AI (2012) Between a rock and a hard place: clinical and imaging features of vascular compression syndromes. Radiographics 32:E33–E49.

    Article  PubMed  Google Scholar 

  19. Wheeler EC, Brenner ZR (1995) Peripheral vascular anatomy, physiology, and pathophysiology. AACN Clin Issues 6:505–514.

    CAS  PubMed  Google Scholar 

  20. i Cuellar CH, Gomez SQ, Cerqueda CS, de la Presa RB, Miranda A (2005) Alvarez-Castells A (2005) Nutcracker or left renal vein compression phenomenon: multidetector computed tomography findings and clinical significance. Eur Radiol 15:1745–1751.

    Article  Google Scholar 

  21. Cope C, Isard HJ (1969) Left renal vein entrapment. A new diagnostic finding in retroperitoneal disease. Radiology 92:867–872.

    Article  CAS  PubMed  Google Scholar 

  22. Lee CT, Katz J, Fearn PA, Russo P (2002) Mode of presentation of renal cell carcinoma provides prognostic information. Urol Oncol 7:135–140.

    Article  PubMed  Google Scholar 

  23. Roy CR 2nd, Wilson T, Raife M, Horne D (1989) Varicocele as the presenting sign of an abdominal mass. J Urol 141:597–599.

    PubMed  Google Scholar 

  24. Cheungpasitporn W, Horne JM, Howarth CB (2011) Adrenocortical carcinoma presenting as varicocele and renal vein thrombosis: a case report. J Med Case Rep 5:337.

    Article  PubMed Central  PubMed  Google Scholar 

  25. Brand TC, Morgan TO, Chatham JR, Kennon WG, Schwartz BF (2001) Adrenal cortical carcinoma presenting as right varicocele. J Urol 165:503.

    Article  CAS  PubMed  Google Scholar 

  26. Shinsaka H, Fujimoto N, Matsumoto T (2006) A rare case of right varicocele testis caused by a renal cell carcinoma thrombus in the spermatic vein. Int J Urol 13:844–845.

    Article  PubMed  Google Scholar 

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Disclosures

Doug Lewis: none. Lars Grimm: Advisory Board, Medscape, LLC. Charles Kim: none.

Funding

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Authors and Affiliations

  1. Department of Radiology, Duke University Medical Center, Box 3808, Durham, NC, 27710, USA

    Douglas S. Lewis, Lars J. Grimm & Charles Y. Kim

Authors
  1. Douglas S. Lewis
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  2. Lars J. Grimm
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  3. Charles Y. Kim
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Correspondence to Lars J. Grimm.

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Lewis, D.S., Grimm, L.J. & Kim, C.Y. Left renal vein compression as cause for varicocele: prevalence and associated findings on contrast-enhanced CT. Abdom Imaging 40, 3147–3151 (2015). https://doi.org/10.1007/s00261-015-0512-y

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  • DOI: https://doi.org/10.1007/s00261-015-0512-y

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