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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 initiallymasqueraded as a pulsating testicle. Other causes of pulsatile scrotal masses include arteriovenous malformation (which has a murmur) and “arteriocele” (atesticular artery that provides a major collateral for an obstructed iliac artery). These conditions are easily differentiated from varicocele by theirphysical and angiographic features.
The take-home message is this: Pulsating veins, irrespective of their location, are pathognomonic of tricuspidinsufficiency.
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