Images of Memorable Cases: Case 86 This teenager with Ebstein’s anomaly had a pulsatile, murmurless, left-sided scrotal mass. 86. Pulsating varicocele resulting from tricuspid insufficiency The prominent scrotal varicosities seen in the image were associated with a large, pulsatile varicocele that initially masqueraded as a pulsating testicle. Other causes of pulsatile scrotal masses include arteriovenous malformation (which has a murmur) and “arteriocele” (a testicular artery that provides a major collateral for an obstructed iliac artery). These conditions are easily differentiated from varicocele by their physical and angiographic features. The take-home message is this: Pulsating veins, irrespective of their location, are pathognomonic of tricuspid insufficiency.