sonography is the first choice of investigation in the detection of varicoceles . in general , they present as multiple serpiginious anechoic lesions around the testis . we report a case of varicocele in a male who presented with history of pain in scrotal region . a 28-year - old male presented with a history of pain in the scrotal region for about 6 months . he was referred to our department for scrotal sonography to evaluate the cause of pain . scrotal sonography revealed multiple dilated veins superior , lateral and inferior to the testis on left side . the flow was sluggish and reflux noted on valsalva manoeuvre for about 6 s. the left testis showed multiple anechoic tubular lesions spontaneously in mediastinal and subcapsular location [ figure 3 ] . b - mode ultrasonography shows multiple serpiginous dilated veins of pampiniform plexus around testis color doppler study shows extratesticular varicocele b - mode ultrasonography and color doppler study show subcapsular and mediastinal location of intratesticular varicocele varicocele occurs as a result of increased venous pressure and incompetence of internal spermatic vein . extratesticular varicocele is a common entity with a reported incidence of 8 - 20% in adult population . most cases are either asymptomatic or associated with a history of orchitis , infertility , scrotal swelling with pain . intratesticular varicoceles are an uncommon condition characterized by dilatation of intra testicular veins and commonly associated with extratesticular varicoceles . sonographic findings of intratesticular varicoceles were first described by weiss et al . who reported a case of dilated testicular vein near the mediastinum testis . it has no prediliction for side and may occur on the left , right , or both testes . . on color doppler imaging flow can be spontaneous or flow could be seen only after the valsalva manoeuvre . the valsalva manoeuvre plays a very important role in the diagnosis of intratesticular varicoceles because in almost half of cases , the flow will not show up spontaneously . tubular types are located within mediastinum testis whereas ovals are located adjacent to the medistinum testis . due to similarity in the flow characteristics of intratesticular and extratesticular varicoceles ,
we report case of a 28-year - old male who had extratesticular varicocele which was associated with intratesticular varicocele . 
 the patient was referred to our department with pain in scrotal region . 
 routine scrotal sonography revealed extratesticular varicocele which was confirmed by color doppler . 
 it was associated with intratesticular varicocele . 
 intratesticular varicocele is a rare condition with a variable sonographic appearance . 
 color doppler sonography is helpful in confirming the diagnosis . 
 detection of intratesticular component is essential in the management of varicoceles .