Extratesticular varicocele is a common clinical condition, occurring in up to 20% of the normal adult male population. It is characterized by dilatation of the veins of the spermatic cord and has well-described sonographic appearances. Intratesticular varicocele is characterized by dilated intratesticular veins and is extremely rare. It usually, but not always, occurs in association with an ipsilateral extratesticular varicocele. We describe the sonographic and colour Doppler appearances of this poorly described entity in a middle-aged man referred for evaluation of a painful left testicular swelling.