Penile emergencies: a review of the main conditions

Abstract

Acute penile conditions, which typically have a traumatic, vascular, or infectious etiology, are rather uncommon and often require prompt medical evaluation. Penile emergencies can be treated conservatively or surgically, and their management often relies on the results of imaging examinations. Because of its high spatial resolution and wide availability, as well as the fact that it does not involve the use of ionizing radiation, ultrasound is the imaging modality of choice in the initial evaluation of penile emergencies. Inconclusive cases can be further evaluated with magnetic resonance imaging. The main purpose of this pictorial essay is to review the main penile emergencies, by presenting illustrative cases, focusing on radiologic findings, and discussing the roles played by the various imaging methods.

Keywords: Emergencies; Emergency medicine; Penile diseases/etiology; Penile diseases/pathology; Radiology; Urology.

Figure 1

A 34-year-old man with penile pain after being kicked by a horse. T2-weighted MRI in axial (a), sagittal (b) and coronal (c) views showing a tear in the tunica albuginea (arrow) and an adjacent hematoma (dotted line).

Figure 2

A 34-year-old man with a 10-day history of penile pain after a surfing accident. a: Contrast-enhanced axial T1-weighted MRI sequence showing a tear in the tunica albuginea extending to the corpus spongiosum and perineum. b: Sagittal T2-weighted MRI sequence showing a hematoma within the corpus spongiosum. c: An unenhanced computed tomography scan acquired 1 month later for the investigation of abdominal pain showing persistence of the hematoma within the corpus spongiosum.

Figure 3

A 38-year-old man with penile pain and swelling after vigorous sexual intercourse. a: Axial ultrasound showing a hematoma (dotted line) adjacent to the right corpus cavernosum; no fracture was identified in the tunica albuginea. Coronal and sagittal T2-weighted MRI sequences (b and c, respectively) showing disruption of the tunica albuginea (arrows) and the adjacent hematoma (dotted line).

Figure 4

A 28-year-old man with a history of a tear in the tunica albuginea. a,b: Retrograde urethrography showing tears in the bulbar and penile urethra (arrows).

Figure 5

A 36-year-old man who had had a mildly painful erection for three days. a: Longitudinal Doppler ultrasound showing increased echogenicity of the corpora cavernosa (asterisks), consistent with tissue edema, and obliteration of the cavernosal arteries (arrows) with no flow on the color Doppler study. b: Duplex scan showing high flow resistance at the dorsal artery of the penis, consistent with low-flow (ischemic) priapism. c: Postoperative axial Doppler ultrasound showing a surgical shunt between the corpus cavernosum and the corpus spongiosum at the glans penis.

Figure 6

A 53-year-old man, with no relevant medical history, complaining of penile pain. Longitudinal B-mode ultrasound showing an echogenic thrombus within the superficial dorsal vein of the penis (arrows in a) with no flow on the color Doppler study (b). Axial B-mode ultrasound (c) showing thrombosis of the superficial dorsal vein of the penis. Note the increased caliber of the vein, which is filled with echogenic material (c). CCD, right corpus cavernosum; CCE, left corpus cavernosum; CE, corpus spongiosum.

Figure 7

An 83-year-old man with pain and edema in the scrotum and perineal region. a: Ultrasound showing thickening and heterogeneity of the skin and subcutaneous tissue of the scrotum and perineal region, with hyperechoic foci and posterior acoustic shadowing (arrows), suggesting gas foci. b: Axial T2-weighted MRI sequence with fat suppression, showing extensive edema in the perineal region, with gas foci (arrows) that were more evident on an axial T1-weighted sequence (c).