Presentation two days after self-inflicted trauma to erect penis. Patient describes cracking sound and instant detumescence. Significant pain and marked swelling and bruising on examination
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At the base of the penis joining the anterior abdominal wall, there is a discontinuity in the inferolateral aspect of the hypointense tunica albuginea surrounding the left corpus cavernosum, consistent with a penile fracture. Fracture shown in both sagittal and axial planes.
An adjacent collection of isointense T1, low T2 signal material has signal characteristics consistent with an acute hematoma.
There is also high T2 signal edema in the left corpus cavernosum at this site, with mild high T2 signal in the immediately adjacent right corpus cavernosum.
Classic history of sudden cracking or popping sound with pain and immediate detumescence. On examination local swelling of the penile shaft is seen and may extend to the lower abdominal wall. The tunica rupture may sometimes be palpable.
Imaging with ultrasound or magnetic resonance imaging may be useful for confirmation.
Subcutaneous hematoma, without rupture of the cavernosal tunica albuginea does not require surgical intervention. Non-steroidal analgesics and ice-packs are recommended.
In penile fracture, early surgical intervention with closure of the tunica albuginea is recommended.