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Intratesticular varicocele is a rare entity, often associated with extratesticular varicocele. Ultrasound with Doppler remains the gold standard for diagnosis. We present a 22-year-old male with right inguinal swelling diagnosed as reducible inguinal hernia. He also reported left scrotal discomfort. Ultrasound revealed a grade IV extra-testicular varicocele with extension into intratesticular parenchyma. Power Doppler confirmed venous flow within dilated intratesticular channels. A trace hydrocele was noted without testicular atrophy. Intratesticular varicocele is an uncommon but important condition. Awareness of this entity is crucial to avoid misdiagnosis. Ultrasound with Doppler remains a reliable diagnostic modality.
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