Ultrasound Case 107

Presentation

A 45 year old man presents with a painful, bruised penis. He described the feeling of a sudden sharp snap and pain on the left side of his erect penis during sexual intercourse. This resulted in immediate detumescence, swelling and pain.

View 1: Long axis left lateral aspect of penis (corpus cavernosum)
USS 107 Image 3 Greyscale

View 2: Transverse short axis view of the penis
USS 107 Image 5 Greyscale

Transverse view of penile anatomy from Radiopaedia

Describe and interpret these scans

IMAGE INTERPRETATION

Image 1 [Video & stills with slider] Long axis left lateral aspect of penis (corpus cavernosum). This demonstrates the site of the tunica albuginea tear and the associated haematoma

Image 2 [Video and stills with slider] Transverse penile image taken from the left lateral approach. This short axis view of the penis demonstrates the deflated left corpus cavernosum with the escaping haematoma laterally.

Image 3: Long axis left lateral aspect of penis (corpus cavernosum). Measurement of the defect in the tunica albuginea.

Image 6 Measurement

CLINICAL CORRELATION

Penile fracture

Penile fracture is a rare urological emergency that requires quick diagnosis and urgent surgical repair. The mechanism of this injury is forceful bending of the erect penis and results in immediate pain and rapid detumescence. This can occur if the erect penis strikes against extravaginal body parts, or during forceful masturbation or manipulation of the penis.

This results in a tear in the tunica albuginea allowing blood to escape to the surrounding soft tissue underneath the deep fascia of the penis (Buck’s fascia). If this fascia is torn, the haematoma can extend to the scrotum, perineum and lower abdominal wall.

The diagnosis is often clear clinically, however ultrasound imaging can confirm suspected cases and also identify the exact location of the tear to help with surgical planning.

References


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Emergency Physician (FACEM). Advanced emergency ultrasound fellow at the Sonocave, Perth, Western Australia

An Emergency physician based in Perth, Western Australia. Professionally my passion lies in integrating advanced diagnostic and procedural ultrasound into clinical assessment and management of the undifferentiated patient. Sharing hard fought knowledge with innovative educational techniques to ensure knowledge translation and dissemination is my goal. Family, wild coastlines, native forests, and tinkering in the shed fills the rest of my contented time. | SonoCPDUltrasound library | Top 100 | @thesonocave |

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