A 30 year old man describes hearing and feeling a snap on the right side of his penis during intercourse. He developed sudden severe pain, rapid detumescence, and then swelling and bruising to the right side of the penile shaft.
View 2: Longitudinal scan of the penis over the right corpus cavernosum
Describe and interpret these scans
Image 1: Transverse scan of the penis from the dorsal approach, proximal to distal.
There is a break in the continuity of the tunica albuginea surrounding the right corpus cavernosum. Dense haematoma has developed at this site and pushes the left corpus cavernosum and corpus spongiosum toward the left.
Image 2: Longitudinal scan of the penis over the right corpus cavernosum.
This again shows the break in the tunica albuginea on the right inferolateral surface of the corpus cavernosum.
Forced sudden compression of the erect penis can rupture the tunica albuginea and cause a fractured penis. Surgical repair reduces long term morbidity from about 30% to 4%. Rupture occurs on the right 75% of the time.
Generally the diagnosis is self evident and imaging is not required, however if there is doubt ultrasound, cavernosography or ideally MRI can assist.
The differential diagnosis includes “false fracture of the penis” which is actually rupture of the superficial or deep dorsal vein of the penis and less frequently injury to the dorsal penile artery or non-specific Dartos bleeding. These patients generally do not hear the “snap” associated with true penile fracture, do not have such rapid detumescence, and a defect in the tunica is not palpable. Once bruising and swelling has appeared it is very difficult to differentiate on clinical examination alone.
Ultrasound is usually done from the volar surface as the corpora cavernosa can be imaged beyond the base of the penis and down toward their origin.