A 23-year-old healthy man has been unable to father a child. He and his wife have a workup for infertility. His wife's reproductive function is normal. On physical examination both his testes are palpable in the scrotum and the testes and scrotum are normal in size, with no masses palpable. However, the spermatic cord on the left has the feel of a 'bag of worms'. Laboratory studies show oligospermia. Which of the following conditions is this man most likely to have? Explain your answer.
A Hydrocele
B Testicular torsion
C Spermatocele
D Varicocele
E Seminoma
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The most likely condition that this man has is D. Varicocele.
Varicocele is a common cause of male infertility and is characterized by the enlargement of the veins within the scrotum. The "bag of worms" feel of the spermatic cord on the left is indicative of varicocele. This can lead to impaired sperm production and oligospermia (low sperm count), which can result in infertility.
A hydrocele is a fluid-filled sac around the testicle, but it would not cause the "bag of worms" feel or impact sperm production.
Testicular torsion is a medical emergency that causes severe testicular pain and requires immediate surgical intervention. It would typically present with a high-riding testis and absent cremasteric reflex, which is not mentioned in the case.
A spermatocele is a benign cystic mass within the epididymis, which does not typically cause infertility or oligospermia.
Seminoma is a type of testicular cancer and would not present with a "bag of worms" feel or impact sperm production.
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