A man aged 50 noticed a tender swelling on the right side of his scrotum. This was diagnosed as a hernia, and he was put on the waiting list for its repair. One year later he was seen in the preadmission clinic and the senior house officer realised that the swelling was a varicocele. Ultrasound scanning and computed tomography showed a bulky renal cancer deforming the vena cava but not invading it. He was treated by radical nephrectomy. A varicocele that presents acutely may indicate pressure on or thrombosis in the spermatic vein within the abdomen.

N E Cetti, consultant urologist, Greenwich District Hospital, London SE10 9HE

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