Rare case of thrombosed varicocele causing severe scrotal and groin pain

Introduction: Thrombosed varicocele is an abnormal enlargement of the veins within the scrotum, which has developed a blood clot. This condition is relatively rare and can cause significant discomfort or pain. Here we present the case of a male in his early twenties with left-sided groin and scrotal pain shown to be caused by a thrombosed varicocele. Case Report: A male in his twenties presented to the emergency department with five days of left-sided groin and scrotal pain. An outpatient ultrasound (US) one day prior to presentation demonstrated a reducible, left-sided indirect inguinal hernia and normal testes. Physical examination on presentation demonstrated a firm, tender, irreducible, left groin lump along the spermatic cord. However, no inguinal or femoral hernia was appreciable on physical examination on both supine and standing examinations. After careful consideration, a decision was made not to operate on this incidental, asymptomatic, image-detected small fatty hernia. A repeat inpatient US of the testes and scrotum was performed which did not show sonographic evidence of acute epididymo-orchitis, or inguinal lymphadenopathy. Repeat physical examinations again did not demonstrate clinical evidence of a hernia. A targeted US of the lump posterior to spermatic cord structures was performed, which demonstrated a thrombosed varicocele is an abnormal enlargement of the veins within the scrotum that has developed a blood clot. This condition is relatively rare and can cause significant pain. Conclusion: Thrombosed varicocele is a rare cause of groin and scrotal pain that can produce a diagnostic challenge.