Lorenc Tomasz, Krupniewski Leszek, Palczewski Piotr, Gołębiowski Marek
1 Department of Clinical Radiology, Medical University of Warsaw, Warsaw, Poland.
J Ultrason. 2016 Dec;16(67):359-370. doi: 10.15557/JoU.2016.0036. Epub 2016 Dec 30.
A varicocele is described as pathologically enlarged, tortuous veins of the pampiniform plexus, leading to an increased testicular temperature and adrenal metabolite reflux into the testes. Varicocele can impair spermatogenesis and is considered to be the most common cause of male infertility. Patients may palpate a thickening in the scrotum or complain of dull scrotal or inguinal pain, which increases when standing or during erection. In the case of a sudden onset of varicocele in elderly men, it is necessary to exclude renal tumor and extend diagnostic ultrasound with the assessment of the abdominal cavity. The diagnosis of varicocele is based on medical history and physical examination, which involves palpation and observation of the scrotum at rest and during the Valsalva maneuver. Ultrasound is the imaging method of choice. The width and the number of vessels in the pampiniform plexus as well as the evaluation and measurement of regurgitation during the Valsalva maneuver are typical parameters analyzed during ultrasound assessment. However, diagnostic ultrasound is still a controversial method due to numerous and often divergent classification systems for varicocele assessment as well as its poor correlation with clinical manifestations. As a result of introduction of clear ultrasound criteria as well as the development of elastography and nuclear magnetic resonance, diagnostic imaging can play an important role in assessing the risk of damage to the testicular parenchyma, qualifying patients for surgical treatment and predicting the effects of therapy.
精索静脉曲张被描述为蔓状静脉丛病理性扩张、迂曲，导致睾丸温度升高以及肾上腺代谢产物反流至睾丸。精索静脉曲张可损害精子发生，被认为是男性不育最常见的原因。患者可触及阴囊增厚，或主诉阴囊或腹股沟钝痛，站立或勃起时疼痛加剧。老年男性突然发生精索静脉曲张时，有必要排除肾肿瘤，并通过评估腹腔来扩展诊断性超声检查。精索静脉曲张的诊断基于病史和体格检查，包括触诊以及观察阴囊在静息状态和瓦尔萨尔瓦动作时的情况。超声是首选的成像方法。蔓状静脉丛中血管的宽度和数量以及瓦尔萨尔瓦动作时反流的评估和测量是超声评估过程中分析的典型参数。然而，由于精索静脉曲张评估的分类系统众多且常常存在分歧，以及其与临床表现的相关性较差，诊断性超声仍然是一种有争议的方法。由于引入了明确的超声标准以及弹性成像和核磁共振的发展，诊断成像在评估睾丸实质损伤风险、确定患者是否适合手术治疗以及预测治疗效果方面可以发挥重要作用。
