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LETTER TO EDITOR
Year : 2022  |  Volume : 17  |  Issue : 1  |  Page : 211-212

Postintercourse extraalbugineal penile hematoma: Ultrasound and elastography appearance


Department of Radiodiagnosis, AVBRH Hospital, Datta Meghe Institute of Medical Sciences, Sawangi, Wardha, Maharashtra, India

Date of Submission20-Jul-2021
Date of Decision08-Jan-2022
Date of Acceptance18-Feb-2022
Date of Web Publication25-Jul-2022

Correspondence Address:
Dr. Suresh Vasant Phatak
Department of Radiodiagnosis, AVBRH Hospital, Datta Meghe Institute of Medical Sciences, Sawangi, Wardha, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jdmimsu.jdmimsu_279_21

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How to cite this article:
Raj N, Phatak SV, Pandey S, Dhawan VB, Gupta R. Postintercourse extraalbugineal penile hematoma: Ultrasound and elastography appearance. J Datta Meghe Inst Med Sci Univ 2022;17:211-2

How to cite this URL:
Raj N, Phatak SV, Pandey S, Dhawan VB, Gupta R. Postintercourse extraalbugineal penile hematoma: Ultrasound and elastography appearance. J Datta Meghe Inst Med Sci Univ [serial online] 2022 [cited 2022 Aug 18];17:211-2. Available from: http://www.journaldmims.com/text.asp?2022/17/1/211/352230



Sir,

We present a case of a 45-year-old man who presented with chief complaint of mild pain and swelling over the shaft of the penis for the past 18 days, he gave preceding history of sexual intercourse after that swelling appeared. There was no history of any other penetrating/blunt trauma. Bowel/bladder habits were normal. On palpation, the swelling was nodular, nontender with no signs of inflammation. Transverse sonogram of penis image reveals a large, irregularly defined hypoechoic area anterior to the left corpora cavernosa with no break in tunica albuginea. There was no associated urethral rupture in this case. On elastography, blue-green-red (BGR) pattern was seen confirming the presence of a predominately cystic lesion.

Penile trauma is a relatively rare condition wherein patients typically present with clinical history pointing toward the diagnosis, but a definitive diagnosis solely based on history is often not possible, imaging techniques particularly sonography helps in establishing the diagnosis and helps us delineate the anatomy, location, nature, and extent of injury. Furthermore, penile vasculature can be assessed using Doppler.[1] Penile trauma can be either penetrating or blunt trauma; the ones with penetrating injury rarely need any imaging as surgical exploration is often needed. Blunt traumatic injuries to the penis usually happen when the penis is erect and is exposed to lateral bending forces. Penile fracture is the most common blunt traumatic injury, wherein there is a tear in the tunica albuginea which results in rupture of one or both corpora cavernosa. Patients with penile fracture typically give history of rapid detumescence with pain and swelling. Often there is an antecedent history of vigorous sexual intercourse. In about 10%–20% of patients with penile fracture there is often a concomitant urethral injury.[2] Another form of blunt traumatic injury is intracavernosal hematoma without penile fracture. This typically results due to injury of subtunical venous plexus and/or smooth muscle trabeculae without a tear in tunica albuginea.[1] The third form of blunt trauma injury is extraalbugineal hematoma wherein the blood collects in subepithelial connective tissue, i.e., the space between Buck's fascia and Colles' fascia [Figure 2] and [Figure 3].[3] On elastography, cysts usually show a “bull's eye” artifact on black-and-white images and an aliasing artifact, the BGR pattern, on color-coded images [Figure 1].[4]
Figure 1: Elastography reveals blue green red pattern consistent with predominantly cystic lesion

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Figure 2: Transverse gray scale sonogram slightly caudal to the longitudinal image reveals a large, irregularly defined hypo-echoic area anterior to left corpora cavernosa

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Figure 3: Longitudinal gray scale sonogram of the penis shows a hypoechoic area near the base of the penis anterior to the left corpora cavernosa

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Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Bhatt S, Kocakoc E, Rubens DJ, Seftel AD, Dogra VS. Sonographic evaluation of penile trauma. J Ultrasound Med 2005;24:993-1000.  Back to cited text no. 1
    
2.
Avery LL, Scheinfeld MH. Imaging of penile and scrotal emergencies. Radiographics 2013;33:721-40.  Back to cited text no. 2
    
3.
Bertolotto M, Mucelli RP. Nonpenetrating penile traumas: Sonographic and Doppler features. AJR Am J Roentgenol 2004;183:1085-9.  Back to cited text no. 3
    
4.
Itoh A, Ueno E, Tohno E, Kamma H, Takahashi H, Shiina T, et al. Breast disease: Clinical application of US elastography for diagnosis. Radiology 2006;239:341-50.  Back to cited text no. 4
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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