Tabriz University of Medical Sciences



Varicocele is the most frequently observed surgically correctable cause of male infertility. Varicocele has been found in approximately 15% to 20% of the general population however, it has  been  diagnosed in one third of infertile man. Researhces suggested severel pathophysiological mechanisms underlying the adverse effects of varicocele. The diagnosis of varicocele is based on medical history and physical examination. But in some cases clinical diagnosis is not reflect severity and it is necessary to use other accurate techniques. The introduction of radiographic diagnostic studies has allowed for improved detection and further characterization of varicoceles. The characteristic ultrasound appearance of a varicocele is that of “multiple, anechoic, serpiginous, tubular structures”, near the superior and lateral aspects of the testis. Color, power or spectral Doppler ultrasound with settings optimized for low flow velocities is commonly used to aid in the diagnosis of varicoceles. Typical Doppler findings include venous flow at rest with intermittent or continuous flow reversal with Valsalva. While the general ultrasound appearance of varicoceles is agreed- upon, there are no standardized criteria regarding the extent of venous dilation or reflux that must be present to meet the definition of a varicocele. In general, clinicians agree that clinically relevant  varicoceles are more than 2.5-3mm in diameter. Different authors use different criteria for defining a varicocele detected ultrasonographically. However other studies suggest that there is no threshold value for the diagnosis of varicocele because vascular structures with retrograde flow on CDU may be smaller than 2mm in diameter. Some says that in order to make a correct diagnosis of varicocele it is necessary to detect a prolonged relux that must be longer than 2s.
The aim of this review article is to answer some
questions. What are the gray scale sonography criteria for diagnosis of varicocele?
What is the rule of color Doppler in diagnosis of varicocele?
Which sonographic findings are more correlate with
patient infertility or testicular atrophy?
Which sonographic criteria correlate with surgical improvement?
What are the sonographic criteria of subclinical varicocele?
What is the importance of reflux time in color
Doppler sonography?
What are the sonographic criteria of varicocele recurrence after surgery?
And finally how a radiologist sould report of gray
scale or Doppler sonography of varicocele.