Extensive Pampiniform Plexus Thrombosis Managed with Rivaroxaban: A Case Report

Pampiniform plexus thrombosis is a rare manifestation of superficial venous thrombosis that can mimic inguinal or scrotal pathology and lacks location-specific management guidance. A 28-year-old man presented with progressive left scrotal pain and swelling. Duplex ultrasound showed a noncompressible thrombus within the pampiniform plexus with absent venous flow and preserved testicular perfusion. Magnetic resonance imaging confirmed an 8-cm thrombus extending toward the deep inguinal ring. Because of the thrombus extent, progressive symptoms, and uncertain propagation risk, an evidence-informed off-label strategy with rivaroxaban 10 mg once daily was chosen after shared decision-making. Symptoms improved rapidly, and follow-up duplex ultrasound on day 45 demonstrated complete recanalization. The patient remained asymptomatic. This case highlights extensive pampiniform plexus thrombosis as a rare vascular–urological entity and suggests that individualized off-label anticoagulation with rivaroxaban may be a feasible therapeutic option when the extent of thrombus and symptom progression raises concern for further propagation.