Images in clinical medicine | Volume 39, Article 131, 15 Jun 2021 | 10.11604/pamj.2021.39.131.29964

Left varicocele revealing a nutcracker phenomenon

Guerroum Hind, Benslima Najwa

Corresponding author: Guerroum Hind, Department of Radiology, Faculty of Medicine, Mohammed VI University of Health Sciences, Cheikh Khalifa International University Hospital, Casablanca, Morocco

Received: 22 May 2021 - Accepted: 01 Jun 2021 - Published: 15 Jun 2021

Domain: Radiology

Keywords: Varicocele, nutcracker phenomenon, Doppler US, Contrast-enhanced CT

©Guerroum Hind et al. Pan African Medical Journal (ISSN: 1937-8688). This is an Open Access article distributed under the terms of the Creative Commons Attribution International 4.0 License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Cite this article: Guerroum Hind et al. Left varicocele revealing a nutcracker phenomenon. Pan African Medical Journal. 2021;39:131. [doi: 10.11604/pamj.2021.39.131.29964]

Available online at: https://www.panafrican-med-journal.com/content/article/39/131/full

Home | Volume 39 | Article number 131

Images in clinical medicine

Left varicocele revealing a nutcracker phenomenon

Left varicocele revealing a nutcracker phenomenon

Guerroum Hind1,&, Benslima Najwa1

 

1Department of Radiology, Faculty of Medicine, Mohammed VI University of Health Sciences, Cheikh Khalifa International University Hospital, Casablanca, Morocco

 

 

&Corresponding author
Guerroum Hind, Department of Radiology, Faculty of Medicine, Mohammed VI University of Health Sciences, Cheikh Khalifa International University Hospital, Casablanca, Morocco

 

 

Abstract

A 14-year-old male adolescent, with no notable medical history presented to a medical consultation with pain and swelling in the left testicle of 5 months duration. Physical examination revealed scrotal varicosities, with small testicular volume. Doppler ultrasound (US) of the left pampiniform plexus and the renal vessels confirmed varicocele grade 3, (dilatation of the left pampiniform plexus of veins with reversal flow during the Valsalva maneuver (A,B) and revealed an associated nutcracker phenomenon (C, arrows). Computed tomography (CT) scan with contrast showed also the compression of the left renal vein (RV) between the superior mesenteric artery (SMA), and the abdominal aorta (AO) confirming the nutcracker phenomenon (NCS) (1) (D, arrows). Our patient was treated by inguinal varicocelectomy and had a partial resolution of symptoms after. He was then referred to a nutritionist to increase BMI in order to treat the NCS, before proceeding to invasive methods. Doppler ultrasound of the renal vessels must be performed in case of left varicocele to assess for an associated NCS (2).

 

 

Figure 1: Doppler ultrasound (US) of the left pampiniform plexus and the renal vessels shows varicocele grade 3, as a dilatation of the left pampiniform plexus of veins with reversal flow during the Valsalva maneuver (A, B) and reveals an associated nutcracker phenomenon (C, arrows); computed tomography (CT) scan with contrast showed also the compression of the left renal vein(RV) between the superior mesenteric artery (SMA), and the abdominal aorta (AO) confirming the nutcracker phenomenon (NCS) (D, arrows)

 

 

 

 

 

 

 

 

Images in clinical medicine

Left varicocele revealing a nutcracker phenomenon

Images in clinical medicine

Left varicocele revealing a nutcracker phenomenon

Images in clinical medicine

Left varicocele revealing a nutcracker phenomenon

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Varicocele

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Contrast-enhanced CT

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