Fracture of the Penis: Demonstration by MRI with Surgical Correlation

Freddie R. Swain, M.D., Michelle Udeschi, M.D., Milton F. Armm, M.D., Joseph A. Gagliardi, M.D.

MRI of a 21-year-old man with a penile fracture demonstrated disruption of the tunica albuginea and adjacent hematoma. Both MRI and subsequent retrograde uretrogram showed that the urethra was not injured. The imaging findings were confirmed at surgery, and the penis was successfully repaired. s

A 21-year-old man presented to the medical center with pain and asymmetric penile swelling after “cracking” his penis. He admitted to a compulsive behavior in which he “cracked” his penis twice per day while in a mildly erect state, “like cracking your knuckles.” Just prior to presenta-tion, the patient experienced an unfamiliar snapping sensa-tion while “cracking” his penis, followed by the acute onset of pain and asymmetric swelling. On physical examination, the patient had a grossly deformed penis with swelling and deviation to the left. The patient also reported having the urge to urinate but was not able to void.

MR imaging of the penis was performed using a torso phased-array coil. With the patient in the supine posi-tion, the penis was elevated with surgical towels. Sagit-

tal T1-weighted, coronal spin echo T1-weighted, axial T2-weighted fat saturated, and coronal T2-weighted fat saturated images were obtained. On coronal T2-weighted fat sat images, the patient had a unilateral 0.8 x 1.8 cm area of disruption of the right posterolateral tunica albuginea involving the mid to distal one-third of the penile shaft, ad-jacent to the corpus cavernosum (Fig. 1). An adjacent 4.6 x 2 cm area of increased signal intensity was felt to represent a hematoma. On axial T2-weighted images, Darto’s fascia was expanded on the right side (Fig. 2). Given his initial inability to void, the patient also underwent a retrograde urethrogram to evaluate the integrity of the urethra (Fig. 3). Although MR imaging had demonstrated no such injury, caution was exercised to insure the best outcome for the patient. The retrograde urethrogram also demonstrated no evidence of urethral injury; and after several attempts, the patient was able to void. His urine was noted to be yel-low without any gross evidence of hematuria.

At surgery, a circumferential incision was performed, with penile degloving and exposure of the corpora cavern-osum and corpus spongiosum. There was disruption of the right posterolateral tunica albuginea involving the mid to distal one-third of the penile shaft, adjacent to the corpus cavernosum. Upon further surgical exploration, surround-ing hematoma was found to be isolated to the penis. The hematoma was evacuated, and the right 1.8 cm tunica lac-eration was repaired with interruputed 2-0 Vicryl sutures. The laceration was noted to have an angle at the center of the laceration, which appeared consistent with the reported mechanism of injury.

83RCR Radiology Case Reports | radiology.casereports.net 2007:2(3):83-85

Case Report

Citation: Swain FR, Udeschi M, Armm MF, Gagliardi JA. Fracture of the Penis: Demon-

stration by MRI with Surgical Correlation. Radiology Case Reports. [Online] 2007;2:75.

Copyright: © Freddie R. Swain, M.D. This is an open-access article distributed under the

terms of the Creative Commons Attribution-NonCommercial-NoDerivs 2.5 License, which

permits reproduction and distribution, provided the original work is properly cited. Com-

mercial use and derivative works are not permitted.

Abbreviations: MRI, magnetic resonance imaging

Freddie R. Swain, M.D.(Email: fswain@stvincents.org), Department of Radiology, St.

Vincent’s Medical Center, Bridgeport, CT, United States of America.

All coauthors are also from the Department of Radiology, St. Vincent’s Medical Center,

Bridgeport, CT, United States of America.

Published: August 10, 2007

DOI: 10.2484/rcr.v2i3.75

Radiology Case ReportsVolume 2, Issue 3, 2007

A penile fracture is defined as rupture of the corpus cavernosum and its surrounding fibroelastic sheath, the tunica albuginea. In order for rupture to occur, there must be sudden increase in intracorporeal pressure by an exter-nal force resulting in tearing the tunica albuginea of the erect penis as in this case [4]. MR imaging is the diagnostic modality of choice because it precisely demonstrates the presence, location, and extent of the tunical tear, which manifests as discontinuity of the tunica albuginea [4-6]. MR imaging also depicts associated injuries to adjacent structures (ie, corpus spongiosum, urethra) [7,8]. The most commonly reported penile injury is disruption of the right posterolateral tunica albuginea involving the mid to distal one-third of the penile shaft, adjacent to the corpus caver-nosum [4, 9-13]. The literature reports a 13-30% incidence of urethral involvement in cases of penile fracture [6, 14-16].

Although penile fractures have been treated conservatively, studies have reported apparent, improved clinical outcomes with early surgical intervention.[1,12,17] If surgical repair is not undertaken, fibrous scar plaques similar to Peyronie’s Disease, may develop causing angulation, bending, and erectile dysfunction.

84RCR Radiology Case Reports | radiology.casereports.net 2007:2(3):83-85

Discussion

Figure 1A. 21-year-old man with fractured penis. Coronal

T2-weighted fat suppressed image demonstrating unilateral

0.8 x 1.8 cm area of disruption of the right posterolateral

tunia albuginea with adjacent 4.6 x 2 cm area of increased

signal intensity representing associated hematoma.

Figure 2. Single radiographic image with contrast in the

urethra depicting a normal retrograde urethrogram without

stricture, filling defect, or extravasation.

Figure 1B. Axial T2-weighted image demonstrating expan-

sion of Darto’s fascia on the right side.

Fracture of the Penis: Demonstration by MRI with Surgical Correlation

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Fracture of the Penis: Demonstration by MRI with Surgical Correlation