A rare testicular vein anatomical variant contributes to right-sided varicocoele formation and leads to the diagnosis of renal cell carcinoma.

Ryan JW, et al. BMJ Case Rep 2017. doi:10.1136/bcr-2017-219519 Description A man in his 60s presented for a testicular ultrasound due to asymptomatic scrotal swelling. Ultrasound showed a right-sided varicocoele (figure 1). A varicocoele is an abnormal dilatation of the pampiniform venous plexus in the scrotum. A renal ultrasound demonstrated a heterogeneous mass arising from the right kidney (figure 2). Histology subsequently revealed a renal cell carcinoma. CT identified duplication of the right testicular vein (figure 3). The first emptied into the inferior venacava (IVC) as expected. The second had a tortuous course arcing over the upper pole of the right kidney and emptying into the right renal vein (figure 4). Tumour extension into the right renal vein obstructed inflow from this accessory testicular vein and contributed to varicocoele formation (figure 5). Less than 1% of males have duplicate right testicular vein anatomy. Ninety-three per cent of varicocoeles occur on the left, the majority of which have a non-pathological aetiology. Differences in testicular vein length, A rare testicular vein anatomical variant contributes to right-sided varicocoele formation and leads to the diagnosis of renal cell carcinoma