Anatomy clinical correlates Quiz: Ace Your Exams

A 24-year-old presents to your office with a complaint of left-sided scrotal mass accompanied by dull-aching pain in the scrotal area. They first noticed a small swelling in the area two months ago, which gradually increased in size, and now their left scrotum feels heavy, especially when they stand. They state “Honestly, it feels a bit like a bag of worms.” Review of systems is otherwise unremarkable. Past medical history is noncontributory. The patient is sexually active and uses condoms consistently. Vitals are within normal limits. Physical examination shows a warm, non-tender, non-fluctuant left scrotal mass that does not transilluminate. The swelling increases in size with the Valsalva maneuver and disappears on lying down. Right scrotum and penis appear normal. Which of the following is the most likely cause of this patient’s condition?