BMJ  2006;332:1199 (20 May), doi:10.1136/bmj.332.7551.1199-a

Commentary

Team perspective

¹ Hillingdon Hospital, Uxbridge, Middlesex UB8 3NN

The first 150 words of the full text of this article appear below.

Mr Mahon's case raises several questions and shows the controversy that often accompanies attempts to define the best management of a complex clinical problem.¹ His initial presentation with a left sided varicocele and a small right sided hydrocele had triggered investigation with ultrasonography. Although varicoceles have been reported in 0.6-11% of patients with renal cell carcinoma,² they are also common in the general population. The cost effectiveness of routine ultrasonography is therefore questionable, although it should be considered in a patient with rapid onset of varicocele.

Mr Mahon is nevertheless fortunate that he had ultrasonography because it also detected a large abdominal aortic aneurysm. His obesity makes it likely that the aneurysm would have remained undetected. Ultrasonography is a potentially important tool for mass screening and surveillance of abdominal aortic aneurysms, and the multicentre aneurysm screening study has shown that screening is cost effective in high risk populations.³ Elective abdominal . . . [Full text of this article]

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