Search Results (122)

Objective: To evaluate and compare fetal arterial and venous Doppler parameters in early-onset (EO) and late-onset (LO) fetal growth restriction (FGR), and to assess their performance within the study cohort and their association with composite adverse neonatal outcome (CANO). Methods: This prospective observational cohort study included 184 singleton pregnancies between 24 and 37 weeks of gestation, comprising 91 FGR cases and 93 appropriate-for-gestational-age controls. FGR was defined according to Delphi consensus criteria and classified as EO-FGR (<32 weeks) or LO-FGR (≥32 weeks). All fetuses underwent standardized Doppler assessment of the umbilical artery (UA), middle cerebral artery (MCA), uterine artery (UtA), and ductus venosus (DV). The cerebroplacental ratio (CPR) was calculated. Multivariable logistic regression models were constructed separately for EO-FGR and LO-FGR. Classification performance was evaluated using receiver operating characteristic analysis. CANO was defined as at least one of the following: 5-min Apgar score <7, respiratory distress syndrome, neonatal intensive care unit admission, or preterm birth. Results: In both EO-FGR and LO-FGR, UA PI values were significantly higher, whereas MCA PI and CPR were significantly lower than in controls. CPR demonstrated the highest discriminative performance among arterial parameters in both subgroups. DV Doppler indices were not significantly different in EO-FGR. In LO-FGR, DV S-wave and v-wave velocities were independently associated with FGR. No significant associations were observed between Doppler parameters and CANO in subgroup analyses. Conclusions: Arterial Doppler parameters, particularly CPR, showed consistent alterations in both EO- and LO-FGR. The contribution of venous Doppler parameters differed according to clinical subtype, with additional value observed in LO-FGR. Full article

Adventitial cystic disease (ACD) is a rare vascular condition, representing approximately 0.1% of all vascular diseases, with about 325 cases reported in the literature since its first description in 1947, including 72 venous cases. This study aims to highlight the diagnostic and therapeutic challenges of venous ACD, which is frequently misdiagnosed as deep vein thrombosis (DVT), femoral varices, aneurysms, venous tumors, or lymphadenopathy due to its rarity. Clinical, imaging, and treatment data from reported cases of venous adventitial cystic disease (VACD) were reviewed. The disease most commonly involved the common femoral vein (56%) and external iliac vein (24%), with less frequent involvement of the saphenous and popliteal veins (7%). Symptoms commonly mimic deep vein thrombosis (DVT), with unilateral swelling resulting from progressive cyst enlargement and subsequent venous luminal stenosis. Doppler ultrasound typically shows a hypoechoic lesion in the venous wall with preserved flow and normal D-dimer levels, while CT angiography and MRI confirm an adventitial cyst occupying ≥ 90% of the lumen without thrombus. Surgical intervention, particularly transadventitial cyst evacuation with excision, is the preferred method of treatment due to lower recurrence rates (7–20%) as compared to cyst aspiration and drainage with higher recurrence (83.3%). These findings highlight the need for heightened clinical suspicion and advanced imaging to optimize the diagnosis and management of venous ACD and reduce misdiagnosis and recurrence. Further studies are needed to optimize diagnostic protocols and treatment strategies, but the limited number of cases hampers meaningful scientific research. Full article

Hypovolemia is a systemic state characterized by severe reduction in the effective blood volume with subsequent tissue hypoperfusion. It may be due to fluid loss, decreased water intake, fluid redistribution, or systemic disease. The present study aimed to evaluate the diagnostic significance of the renal artery resistive index (RRI), caudal vena cava (CVC) diameter, and aorta (Ao) diameter in dogs with hypovolemia. For this purpose, 30 dogs (hypovolemic, n = 15; control, n = 15) were investigated. Clinical variables and hematological findings were investigated for each dog. Pulsed-wave Doppler ultrasound was performed to measure the RRI and diameters of the CVC and Ao. Ultrasound examination revealed a markedly elevated RRI (p < 0.001) and significantly reduced CVC (p < 0.001) and Ao (p < 0.001) diameters in hypovolemic dogs compared to controls, reflecting increased vascular resistance and impaired venous return. Biochemical analysis showed significant increases in blood urea nitrogen (BUN) and BUN:Cr ratio, while Cr remained unchanged. Hematological variables demonstrated limited diagnostic value, with only mild increases in packed cell volume (PCV%). Correlation analysis confirmed a strong positive correlation between RRI and BUN (r = 0.917; p < 0.01), RRI and BUN:Cr ratio (r = 0.664; p < 0.01), and CVC and Ao diameters (r = 0.832; p < 0.05). Receiver operating characteristic (ROC) analysis with area under the curve (AUC) identified RRI (AUC = 0.99), CVC diameter (AUC = 0.93), and Ao diameter (AUC = 0.88) as highly accurate markers of hypovolemia, whereas the CVC:Ao ratio and hematological markers provided poor discrimination. Logistic regression confirmed significant diagnostic value for RRI, CVC diameter, Ao diameter, and BUN, but final multivariate analysis revealed RRI as the sole independent early diagnostic marker (p < 0.001; OR: 196.0; 95% CI: 11.12–34.72). In conclusion, RRI measured by Doppler ultrasound is the most reliable and sensitive early diagnostic marker for hypovolemia in dogs, outperforming conventional biochemical and hematological markers. Full article

Background: Reactive hyperemia (RH) is used to assess microcirculatory function in vivo and has traditionally been interpreted as a local, ischemia-driven vasodilatory response following arterial occlusion. However, perfusion changes consistently observed in contralateral, non-challenged limbs question the exclusively local nature of RH. Objective: This study aimed to characterize reactive hyperemic responses elicited by subsystolic cuff pressures, below arterial occlusion pressure (AOP), and to investigate their effects on glabrous and non-glabrous skin microcirculation and on global hemodynamics. Methods: Seven healthy women underwent a standardized protocol consisting of baseline stabilization, a 2 min subsystolic cuff inflation (70–80% of resting AOP) in one arm, and a recovery period. Microvascular perfusion was simultaneously assessed in both hands using laser Doppler flowmetry (LDF) on glabrous skin and polarized light spectroscopy (PSp) on non-glabrous dorsal skin. Hemodynamic indicators were continuously monitored using CNAP (Continuous Non-invasive Arterial Pressure) technology. Ipsilateral and contralateral responses were compared across experimental phases. Results: Subsystolic cuff inflation induced significant perfusion changes not only in the challenged limb but also in the contralateral limb, despite the absence of a complete arterial occlusion. Conclusions: These findings confirm the adaptive nature of RH emphasizing the major role for the sympathetic nervous system in glabrous skin. In glabrous (palmar) skin, a similar perfusion profile is shown in both hands but significant differences could only be found in the ipsilateral hand. In contrast, non-glabrous (dorsal) skin demonstrated region-specific increases in perfusion, again evident in the ipsilateral hand, suggesting venous stasis. No changes in global hemodynamic variables were observed throughout the protocol. Further studies in larger, more diverse populations are needed to confirm these observations and refine the mechanistic understanding of reactive hyperemia. Full article

Background: Erectile dysfunction (ED) is increasingly recognized as an early manifestation of systemic vascular disease and might represent a window for cardiovascular risk assessment. Dynamic penile colour Doppler ultrasound (PCDU) provides quantitative arterial and venous parameters that could reflect subclinical vascular impairment. We investigated the association between PCDU parameters and estimated cardiovascular risk in men with ED. Methods: In this single-center retrospective observational study, 275 men undergoing PCDU for ED were evaluated. Clinical characteristics, biochemical data, and QRISK3 10-year cardiovascular risk scores were collected. Mean peak systolic velocity (PSV), end-diastolic velocity (EDV), and resistive index (RI) were analyzed. Correlation analyses, logistic regression using a QRISK3 ≥ 10% threshold, linear regression models, age-stratified analyses, and receiver operating characteristic (ROC) curve analyses were performed. Results: Patients with impaired PSV (<35 cm/s) were older and exhibited higher QRISK3 scores and a greater prevalence of diabetes mellitus and previous cardiovascular events. Mean PSV was inversely correlated with QRISK3 (r = −0.203, p < 0.01) and was associated with higher cardiovascular risk categories in unadjusted logistic regression (β = −0.016, p = 0.048), but not after adjustment for age and diabetes mellitus. ROC analysis showed modest discrimination of increased cardiovascular risk (AUC = 0.60). The addition of PSV to a model including age and diabetes resulted in minimal improvement in discrimination (AUC 0.966 vs. 0.968). Age-stratified analysis demonstrated a significant association between lower PSV and higher cardiovascular risk only in patients ≤60 years. A progressive increase in QRISK3 was observed according to the number of abnormal Doppler parameters (p = 0.013). Conclusions: PCDU parameters reflect the overall cardiovascular risk burden in men with ED. Although not independent predictors beyond traditional risk factors, penile Doppler abnormalities might identify a vascular phenotype associated with higher estimated cardiovascular risk, particularly in younger individuals. These findings support the role of comprehensive vascular assessment in selected patients with ED. Full article

Background: Vascular malformations are congenital structural abnormalities of the blood vessels that may present at any age. In the vulvovaginal region, these lesions are uncommon and frequently misdiagnosed because their clinical appearance overlaps with common gynecologic conditions, particularly Bartholin’s gland cyst or abscess. Inappropriate surgical intervention without prior vascular evaluation may result in hemorrhage, incomplete treatment, and recurrence. Methods: A structured narrative review of the literature was performed using PubMed/MEDLINE and EMBASE databases (January 2000–April 2024) to summarize the classification, pathophysiology, clinical presentation, imaging characteristics, differential diagnosis, and management of vulvovaginal vascular malformations. Publications addressing vascular anomalies in other anatomical locations were also included when clinically relevant. A representative clinical case confirmed by histopathologic and molecular analysis is presented to illustrate the diagnostic pitfalls. Results: Vulvovaginal vascular malformations are predominantly low-flow venous lesions but may include high-flow arteriovenous malformations. A clinical examination alone is insufficient for diagnosis. Doppler ultrasonography is the recommended initial imaging modality, followed by magnetic resonance imaging to define the lesion extent and flow characteristics. Misdiagnosis most commonly occurs when lesions are treated as Bartholin’s gland pathology without prior imaging. Low-flow lesions are generally managed with sclerotherapy or planned surgical excision, whereas high-flow lesions require embolization and multidisciplinary care. Hormonal and hemodynamic changes, including pregnancy, may precipitate enlargement or thrombosis. Conclusions: Vascular malformations should be considered in the differential diagnosis of atypical vulvar masses. Preoperative imaging is essential in order to avoid inappropriate surgical procedures. A structured diagnostic approach combining clinical assessment and imaging enables correct classification and guides treatment. The presented case demonstrates a typical diagnostic pitfall and emphasizes the importance of recognizing vascular lesions in gynecologic practice. Full article

Background: Systemic venous congestion is a key driver of organ dysfunction in heart failure (HF), yet accurate non-invasive quantification remains challenging. Recognizing residual congestion is critical, since it predicts HF readmissions and mortality. Traditional assessments (physical exam, jugular venous pressure, inferior vena cava [IVC] size) are imprecise. The Venous Excess Ultrasound Score (VExUS) is a semi-quantitative point-of-care ultrasound (POCUS) protocol that integrates IVC diameter with Doppler flow patterns in the hepatic, portal and intrarenal veins to grade systemic venous overload. Methods: We conducted a narrative review of literature (2018–2025) regarding the usefulness of VExUS in HF, covering congestion pathophysiology, clinical evidence (hemodynamic correlations, organ dysfunction, outcomes), potential applications, integration with lung ultrasound, echocardiography and biomarkers, limitations of its assessment and future directions. Results and Discussions: In HF, elevated right atrial pressure causes venous congestion. VExUS integrates IVC diameter with Doppler waveforms of hepatic, portal, and intrarenal veins to grade congestion. Emerging evidence shows higher VExUS grades correlate with elevated filling pressures, renal dysfunction, and worse outcomes. Its use may guide diuretic therapy, aid discharge planning, and monitor outpatient congestion, especially when combined with lung ultrasound and biomarkers. However, VExUS has limitations: it is technical and operator-dependent. Importantly, large trials validating VExUS-guided management are lacking. Future directions include AI-driven automation of Doppler analysis and integration with multimodal congestion monitoring to provide a comprehensive congestion assessment. Conclusions: VExUS is a promising noninvasive tool for quantifying congestion in HF. Higher grades are associated with organ dysfunction and poor prognosis. Incorporating this technique into HF care may improve congestion-guided therapy, but large-scale validation is required before routine use. Full article

Background/Objectives: Chronic venous disease (CVD) is a prevalent condition marked by valve dysfunction and increased pressure in lower limb veins. The trans-nodal veins in the inguinal region and Scarpa triangle, which connect the superficial and deep venous systems, provide new insight into venous insufficiency pathways. While they function normally in healthy individuals, they can become dilated in chronic venous disease or following surgery. The purpose of this study was to provide an ultrasonographic anatomical description of intranodal varicose veins and to assess possible changes in the stiffness of varicose, dilated inguinal lymph nodes. Methods: The study comprised 92 participants, including 69 women and 23 men, who underwent Doppler ultrasound examinations of the lower-limb venous system, focusing on the groin from both a descriptive morphological and an elastographic perspective. The diagnosis of lymph node varices was made according to established criteria, its severity was assessed using an original classification system, and shear-wave elastography (SWE) values were recorded. Results: More than 83% of patients with operated CVD had lymph node varicose veins. Patients with lymph node varicose veins had larger groin lymph node diameters than patients with CVD without lymph node varicose pathology. The mean shear wave elastography values were significantly lower in the group with lymph node varices compared to the group without (12.2 ± 1.1 kPa vs. 20.1 ± 2.3 kPa; p < 0.05). Elastographic values correlate with lymph node diameter (p = 0.039) and with varicose vein grade (p < 0.001). Conclusions: Intranodal varices may indicate disease progression. These vascular abnormalities impact SWE measurements by altering tissue mechanics. It is imperative to consider the interactions between the lymphatic and venous systems in the management of CVD to improve patient outcomes. Full article

The physiological impact of neoadjuvant therapy on vascular and thermal responses in breast cancer patients remains poorly understood, despite its clinical relevance for predicting treatment outcomes and managing therapy-related side effects. Sensor-based monitoring technologies, such as thermography and Doppler ultrasound, provide non-invasive approaches to assess circulatory and thermal changes, potentially serving as predictive biomarkers of therapeutic efficacy. This study aimed to evaluate vascular impairment and correlate circulatory alterations with skin surface temperature in women undergoing neoadjuvant therapy for breast cancer. A total of 38 women were enrolled and distributed into two groups: patients receiving eight cycles of neoadjuvant chemotherapy and healthy controls. Thermographic imaging was employed to measure upper-limb surface temperature, while Doppler ultrasound assessed arterial and venous blood flow in the cubital fossa. Paired Student’s t-tests compared experimental moments (C1, C5, C8), with normality assessed from difference scores (Δ) and results expressed as mean differences with 95% CIs (p < 0.05, two-tailed). Associations between surface temperature and arterial blood flow were examined using simple linear regression (R², F-statistic, β, p-values). Analyses were performed in SPSS 20.0 (SPSS Inc., Chicago, IL, USA). Significant increases in surface temperature (p < 0.001) and blood flow velocity (p < 0.004) were observed in patients compared with controls prior to therapy, suggesting pre-existing vascular and thermal dysregulation. Neoadjuvant therapy significantly altered thermal and vascular dynamics, reinforcing the utility of sensor-based monitoring to capture subtle physiological responses during treatment. Full article

Background/Objectives: Umbilical–portal–systemic venous shunts (UPSVS) are rare fetal vascular anomalies with heterogeneous embryologic origins and variable perinatal implications. Although prenatal diagnosis has increased with advances in fetal imaging, data correlating prenatal subclassification with structural/genetic abnormalities and neonatal outcomes remain limited. Methods: This retrospective study included 50 fetuses prenatally diagnosed with UPSVS at a tertiary referral perinatology center between 2021 and 2025. Cases were subclassified according to the Achiron prenatal classification into Type 1 umbilical–systemic shunt (USS), Type 2 ductus venosus–systemic shunt (DVSS), Type 3a intrahepatic portosystemic shunt (IHPSS), and Type 3b extrahepatic portosystemic shunt (EHPSS). Prenatal ultrasound, Doppler, fetal echocardiography, and genetic testing (karyotype and chromosomal microarray) were analyzed. Perinatal metrics—including structural/genetic anomalies, fetal growth restriction (FGR), termination of pregnancy (TOP), and neonatal outcomes—were evaluated with postnatal verification. Results: The distribution of subtypes was Type 1: 28% (14/50), Type 2: 48% (24/50), Type 3a: 20% (10/50), and Type 3b: 4% (2/50). Gestational age at diagnosis was significantly higher in Type 3a compared with Type 1 and Type 2 (32.2 ± 2.4 vs. 21.1 ± 6.7 and 22.4 ± 5.8 weeks; p < 0.001). Structural anomalies were most frequent in Type 1 (13/14, 92.9%; p < 0.001), while FGR predominated in Type 3a (9/10, 90%; p = 0.006). Ductus venosus (DV) agenesis was universal in Type 1 (14/14) and Type 3b (2/2), absent in Type 2 (0/24), and present in 20% of Type 3a (2/10) (p < 0.001). Genetic abnormalities were detected in 57% of Type 1 (4/7) and 56% of Type 2 (9/16) fetuses, with trisomy 21 most prevalent in Type 2. TOP was highest in Type 1 (8/14, 57.1%; p < 0.001). Adverse neonatal outcomes occurred primarily in Type 1 and Type 3b (p < 0.001), whereas Type 2 demonstrated favorable neonatal outcomes. Conclusions: UPSVS subtype is strongly associated with structural/genetic anomalies, FGR, and neonatal outcomes, underscoring the importance of prenatal subclassification in prognostic assessment and counseling. Type 1 and Type 3b represent the highest—risk subgroups requiring delivery planning in tertiary centers, while Type 2 generally exhibits a benign perinatal course. The association between Type 3a and FGR highlights the need for detailed evaluation of the hepatic venous system in growth-restricted fetuses. However, interpretation of subgroup-specific associations should consider the relatively small sample size of Type 3b cases and the limited genetic testing performed in some Type 3a fetuses. Multicenter prospective studies are warranted to standardize diagnostic algorithms, optimize genetic testing strategies, and refine perinatal management. Full article

Background: Vascular injury after total knee arthroplasty (TKA) is rare but may be limb-threatening. Popliteal artery branch pseudoaneurysm is an uncommon complication that can present with nonspecific symptoms, potentially mimicking postoperative hematoma, infection, or deep venous thrombosis (DVT). Case presentation: A 79-year-old man underwent primary left TKA for advanced osteoarthritis (OA). Seven months later, he sustained a low-energy fall closed reduction and bracing were implemented. Due to recurrent episodes of instability with spontaneous self-reduction, a constrained revision TKA (R-TKA) was performed. Eighteen days after revision, the patient was readmitted because of persistent pain-related functional impairment. Duplex Doppler ultrasonography revealed a partially thrombosed pseudoaneurysm measuring 33 × 37 mm arising from a popliteal/genicular branch. Computed tomography angiography (CTA) confirmed a partially thrombosed pseudoaneurysm with a contrast-filled component within a larger periarticular fluid collection. This suggested a second, smaller pseudoaneurysm along the feeding vessel; hemarthrosis and soft-tissue edema were also present. After multidisciplinary evaluation, selective catheter angiography via left common femoral access was performed, and the injured branch was occluded using coil embolization combined with n-butyl cyanoacrylate tissue adhesive. Completion angiography demonstrated successful exclusion of the pseudoaneurysm without complications. Conclusions: Delayed pseudoaneurysm of a popliteal artery branch should be considered after revision TKA in patients with atypical swelling, hemarthrosis, or disproportionate pain. Duplex ultrasound and CTA are complementary diagnostic tools, and endovascular embolization provides a minimally invasive, effective, and low-morbidity treatment option when the lesion involves a branch vessel. Full article

Background/Objectives: In this study, we aimed to evaluate whether neonatal ischemia-modified albumin (IMA) and umbilical venous cord blood gas parameters are associated with antenatal markers of fetal well-being, including the umbilical coiling index (UCI) and umbilical artery (UA) and middle cerebral artery (MCA) Doppler indices. Methods: For this prospective observational study, sixty-five low-risk term pregnancies (≥37 weeks) were included. Prenatal ultrasound was used to measure the UCI and UA/MCA Doppler indices. At delivery, umbilical venous cord blood gas and serum IMA analyses were performed. Maternal and neonatal data (birth weight, 5 min Apgar score, NICU admission, sex, and delivery mode) were recorded, and correlations and group comparisons were performed (p < 0.05). Results: The UCI ranged from 0.210 to 0.471 coil/cm (mean 0.337). The UA and MCA Doppler indices were within the reference ranges. The UCI showed no significant correlation with umbilical venous blood gas values, IMA, UA/MCA Doppler indices, gestational age/weeks, or 5 min Apgar score. The UA S/D ratio and UA resistive index (RI) were negatively correlated with birth weight (p < 0.05). Umbilical venous pH was positively correlated with the 5 min Apgar score, whereas venous pCO₂ was negatively correlated with the 5 min Apgar score (both p < 0.05). Newborns with venous pH < 7.32 had higher cesarean delivery rates and higher rooming-in rates. Newborns admitted to the NICU had higher mean UA systolic velocity/diastolic velocity (S/D) and UA pulsatility index (PI) and lower venous pH. Conclusions: In low-risk term pregnancies, the UCI was not associated with cord blood gas parameters, IMA, or UA/MCA Doppler indices. These results suggest that the UCI may have limited clinical utility as a predictor of early neonatal acidosis or oxidative stress in a strictly low-risk population. Full article

Nicolau syndrome, also known as embolia cutis medicamentosa, is a rare iatrogenic reaction that may occur following parenteral drug administration, including inadvertent intra-arterial or periarterial injection. Its pathophysiology remains poorly understood; however, several mechanisms have been proposed, including vasospasm, embolization, cytotoxic inflammation, and secondary tissue necrosis. We report the case of a 22-year-old transgender woman who received intravenous benzathine penicillin in the left arm without a medical prescription following a reactive syphilis screening performed outside a formal healthcare setting. She subsequently developed severe pain, livedoid dermatitis, pallor, distal cyanosis, and blister formation. Radial and brachial pulses remained palpable, and Doppler ultrasonography revealed no evidence of arterial or venous thrombosis. Medical management included daily wound care, anticoagulation, corticosteroids, peripheral vasodilators, antibiotic therapy, and analgesia. The patient was hospitalized for nine days, with partial clinical improvement. However, persistent distal ischemic changes involving the second through fifth fingers raised concern for evolving necrosis and potential amputation. After counseling regarding these risks, the patient requested voluntary discharge. This case underscores the importance of safe medication administration and appropriate injection practices, particularly in low-resource settings. It also highlights the need for improved training of healthcare personnel to ensure early recognition and prompt management of Nicolau syndrome, as well as strengthened patient education to discourage self-medication and promote timely care by qualified healthcare professionals. Full article

Background/Objectives: Varicocele repair can improve semen parameters and pregnancy rates in appropriately selected men; however, persistence or recurrence remains a common cause of treatment failure with ongoing infertility or scrotal pain. Because mechanisms and definitions vary across studies, counseling and salvage selection can be challenging. This review synthesizes contemporary evidence on why varicocele recur and provides an anatomy-informed approach to evaluation and retreatment. Methods: A narrative evidence synthesis was performed using PubMed/MEDLINE, prioritizing clinical practice guidelines, systematic reviews, meta-analyses, and contemporary adult and adolescent clinical series addressing mechanisms of failure, diagnostic workup, and outcomes of salvage microsurgery and endovascular therapy. Results: Recurrence rates vary by technique and follow-up, with the lowest rates reported in contemporary microsurgical subinguinal series. The dominant drivers of failure are incomplete venous control and complex reflux pathways, including duplicated internal spermatic veins and missed collaterals such as cremasteric, external spermatic, gubernacular, and deferential veins. Clinical examination remains central; Doppler ultrasonography is most useful when pain persists or semen parameters and testicular growth do not improve. Venography can define culprit channels in complex or multiply treated cases and enables targeted embolization. Retreatment achieves high anatomic success with consistent improvements in semen parameters and meaningful pregnancy rates in available series, with modality-specific complication profiles. Conclusions: Recurrent varicocele should be managed with structured reassessment that links venous anatomy and the index procedure to the salvage option. Microsurgical redo is generally favored after non-microscopic repairs, whereas endovascular occlusion is often preferred after prior surgery or when venographic mapping is needed. Full article

Objectives: This study aimed to investigate the impact of scrotal pain on venous diameter and reflux duration in varicocele, and to assess the predictive value of ultrasonographic findings for varicocele grading. Methods: Fifty-two symptomatic patients with left-sided varicocele, presenting with infertility or scrotal pain, were prospectively evaluated. Grading was based on physical examination. Visual Analog Scale (VAS) scores, venous diameters, and reflux durations were measured using scrotal color Doppler ultrasonography (CDUS) both during active pain and after pain had markedly subsided or resolved. Results: After pain resolution, venous diameters significantly decreased in both resting and Valsalva states (p < 0.001). In grade-specific analysis, this reduction was significant only in grade II varicocele (rest: p = 0.004; Valsalva: p = 0.026). Reflux durations also significantly decreased after pain relief in all varicocele grades, both at rest and during Valsalva (p < 0.001 for all, except G3 Valsalva: p = 0.001). Ultrasonographic parameters during the pain-present state showed better discrimination for detecting grade I varicocele (AUC: 0.88), while the pain-free state provided better diagnostic accuracy for grade III varicocele (AUC: 0.69). Combining measurements from both conditions further improved predictive accuracy, especially for grade III varicocele (AUC: 0.77). Conclusions: Scrotal pain significantly influences scrotal CDUS findings in patients with varicocele, leading to measurable differences in venous diameter and reflux duration between pain-present and pain-free states. Therefore, consideration of symptom status when interpreting scrotal CDUS results may improve diagnostic accuracy and support more informed clinical decision-making. Full article