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Images of Memorable Cases: Case 86

Module by: Herbert L. Fred, MD, Hendrik A. van Dijk. E-mail the authorsEdited By: Frederick Moody

http://rup.rice.edu/memcases-button.jpg

Case_86-pres1-1.jpg

This teenager with Ebstein’s anomaly had a pulsatile, murmurless, left-sided scrotal mass.

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.

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