A sudden onset left-sided varicocele in an older man should raise suspicion for which condition?

• A. Renal cell carcinoma
• B. Testicular torsion
• C. Epididymal cyst
• D. Prostate cancer

Answer: (A)

A new, sudden left-sided varicocele in an older man signals a possible renal cell carcinoma because a tumor in the left kidney can invade or compress the left renal vein, causing backpressure that dilates the left testicular (pampiniform) venous system. The left testicular vein drains into the left renal vein, so a mass in the kidney on that side is a classic cause of this pattern. This scenario is a red flag for RCC and prompts abdominal imaging to look for a renal mass.

In contrast, testicular torsion presents with acute scrotal pain and is more common in younger patients; an epididymal cyst is usually a benign, incidental finding and doesn’t typically cause a sudden venous dilation; prostate cancer doesn’t typically cause a new varicocele.