MR Imaging of Acute Penile Fracture1
Moon-Hae Choi, MD ,
Bohyun Kim, MD ,
Jeong-Ah Ryu, MD ,
Sung Won Lee, MD and
Kyu Sung Lee, MD
1 From the Departments of Radiology (M.H.C., B.K., J.A.R.) and Urology (S.W.L., K.S.L.), Samsung Medical Center, 50 Ilwon-Dong, Kangnam-Ku, Seoul 135-710, South Korea. Presented as a scientific exhibit at the 1999 RSNA scientific assembly. Received February 28, 2000; revision requested April 3 and received May 19; accepted May 23. Address correspondence to B.K. (e-mail: bhkim@smc.samsung.co.kr).
View larger version (138K):
[in a new window]
|
Figure 1a. Normal penile anatomy. (a) Drawing illustrates the inferior view of the perineum and penis after removal of the skin and dartos fascia. Note the thick envelopes covering the corpora cavernosa and corpus spongiosum (Buck fascia). (b) Drawing illustrates the inferior view of the three erectile bodies of the penis after further removal of the Buck fascia: the two corpora cavernosa laterally (CC) and the corpus spongiosum ventrally (CS). The distal part of the corpus spongiosum forms the glans. The corpora cavernosa and corpus spongiosum are covered with a dense, fibrous tissue layer (tunica albuginea). (c) Drawing illustrates a transverse section through the shaft of the penis. The tunica albuginea is seen enveloping the two corpora cavernosa (CC) and the corpus spongiosum (CS). The deep dorsal vein and dorsal arteries are also seen.
|
|
View larger version (176K):
[in a new window]
|
Figure 1b. Normal penile anatomy. (a) Drawing illustrates the inferior view of the perineum and penis after removal of the skin and dartos fascia. Note the thick envelopes covering the corpora cavernosa and corpus spongiosum (Buck fascia). (b) Drawing illustrates the inferior view of the three erectile bodies of the penis after further removal of the Buck fascia: the two corpora cavernosa laterally (CC) and the corpus spongiosum ventrally (CS). The distal part of the corpus spongiosum forms the glans. The corpora cavernosa and corpus spongiosum are covered with a dense, fibrous tissue layer (tunica albuginea). (c) Drawing illustrates a transverse section through the shaft of the penis. The tunica albuginea is seen enveloping the two corpora cavernosa (CC) and the corpus spongiosum (CS). The deep dorsal vein and dorsal arteries are also seen.
|
|
View larger version (189K):
[in a new window]
|
Figure 1c. Normal penile anatomy. (a) Drawing illustrates the inferior view of the perineum and penis after removal of the skin and dartos fascia. Note the thick envelopes covering the corpora cavernosa and corpus spongiosum (Buck fascia). (b) Drawing illustrates the inferior view of the three erectile bodies of the penis after further removal of the Buck fascia: the two corpora cavernosa laterally (CC) and the corpus spongiosum ventrally (CS). The distal part of the corpus spongiosum forms the glans. The corpora cavernosa and corpus spongiosum are covered with a dense, fibrous tissue layer (tunica albuginea). (c) Drawing illustrates a transverse section through the shaft of the penis. The tunica albuginea is seen enveloping the two corpora cavernosa (CC) and the corpus spongiosum (CS). The deep dorsal vein and dorsal arteries are also seen.
|
|
View larger version (114K):
[in a new window]
|
Figure 2a. Normal penile anatomy. (a) Axial T1-weighted MR image shows the corpora cavernosa (CC) and corpus spongiosum (CS) with intermediate to low signal intensity. CA = cavernous artery, U = urethra. (b) Axial T2-weighted MR image shows the corpora cavernosa (CC) and corpus spongiosum (CS) with high signal intensity. CA = cavernous artery, U = urethra. (c) Sagittal T2-weighted MR image also shows the corpora cavernosa (CC) with high signal intensity. The tunica albuginea (arrow) has low signal intensity with all sequences.
|
|
View larger version (104K):
[in a new window]
|
Figure 2b. Normal penile anatomy. (a) Axial T1-weighted MR image shows the corpora cavernosa (CC) and corpus spongiosum (CS) with intermediate to low signal intensity. CA = cavernous artery, U = urethra. (b) Axial T2-weighted MR image shows the corpora cavernosa (CC) and corpus spongiosum (CS) with high signal intensity. CA = cavernous artery, U = urethra. (c) Sagittal T2-weighted MR image also shows the corpora cavernosa (CC) with high signal intensity. The tunica albuginea (arrow) has low signal intensity with all sequences.
|
|
View larger version (129K):
[in a new window]
|
Figure 2c. Normal penile anatomy. (a) Axial T1-weighted MR image shows the corpora cavernosa (CC) and corpus spongiosum (CS) with intermediate to low signal intensity. CA = cavernous artery, U = urethra. (b) Axial T2-weighted MR image shows the corpora cavernosa (CC) and corpus spongiosum (CS) with high signal intensity. CA = cavernous artery, U = urethra. (c) Sagittal T2-weighted MR image also shows the corpora cavernosa (CC) with high signal intensity. The tunica albuginea (arrow) has low signal intensity with all sequences.
|
|
View larger version (107K):
[in a new window]
|
Figure 3a. Tear of the tunica albuginea. (a) Axial T1-weighted MR image demonstrates discontinuity of the low-signal-intensity tunica albuginea (arrow) and surrounding hematoma (*) in the ventral aspect of the right corpus cavernosum. (b) Sagittal T2-weighted MR image obtained in a different patient shows disruption of the tunica albuginea (arrow) with surrounding hematoma (*) in the penile midshaft. (c, d) Coronal (c) and sagittal (d) T2-weighted MR images obtained in yet another patient demonstrate a transverse tear of the tunica albuginea (arrow) with surrounding hematoma (*).
|
|
View larger version (92K):
[in a new window]
|
Figure 3b. Tear of the tunica albuginea. (a) Axial T1-weighted MR image demonstrates discontinuity of the low-signal-intensity tunica albuginea (arrow) and surrounding hematoma (*) in the ventral aspect of the right corpus cavernosum. (b) Sagittal T2-weighted MR image obtained in a different patient shows disruption of the tunica albuginea (arrow) with surrounding hematoma (*) in the penile midshaft. (c, d) Coronal (c) and sagittal (d) T2-weighted MR images obtained in yet another patient demonstrate a transverse tear of the tunica albuginea (arrow) with surrounding hematoma (*).
|
|
View larger version (89K):
[in a new window]
|
Figure 3c. Tear of the tunica albuginea. (a) Axial T1-weighted MR image demonstrates discontinuity of the low-signal-intensity tunica albuginea (arrow) and surrounding hematoma (*) in the ventral aspect of the right corpus cavernosum. (b) Sagittal T2-weighted MR image obtained in a different patient shows disruption of the tunica albuginea (arrow) with surrounding hematoma (*) in the penile midshaft. (c, d) Coronal (c) and sagittal (d) T2-weighted MR images obtained in yet another patient demonstrate a transverse tear of the tunica albuginea (arrow) with surrounding hematoma (*).
|
|
View larger version (100K):
[in a new window]
|
Figure 3d. Tear of the tunica albuginea. (a) Axial T1-weighted MR image demonstrates discontinuity of the low-signal-intensity tunica albuginea (arrow) and surrounding hematoma (*) in the ventral aspect of the right corpus cavernosum. (b) Sagittal T2-weighted MR image obtained in a different patient shows disruption of the tunica albuginea (arrow) with surrounding hematoma (*) in the penile midshaft. (c, d) Coronal (c) and sagittal (d) T2-weighted MR images obtained in yet another patient demonstrate a transverse tear of the tunica albuginea (arrow) with surrounding hematoma (*).
|
|
View larger version (144K):
[in a new window]
|
Figure 4a. Intracavernosal hematoma without tear of the tunica albuginea. (a) Axial T1-weighted MR image demonstrates a small, round hematoma with high signal intensity in the left corpus cavernosum (*). (b, c) On axial (b) and sagittal (c) T2-weighted MR images, the hematoma appears isointense relative to surrounding tissue. Note the intact, low-signal-intensity tunica albuginea (arrow). CC = corpus cavernosum, CS = corpus spongiosum.
|
|
View larger version (157K):
[in a new window]
|
Figure 4b. Intracavernosal hematoma without tear of the tunica albuginea. (a) Axial T1-weighted MR image demonstrates a small, round hematoma with high signal intensity in the left corpus cavernosum (*). (b, c) On axial (b) and sagittal (c) T2-weighted MR images, the hematoma appears isointense relative to surrounding tissue. Note the intact, low-signal-intensity tunica albuginea (arrow). CC = corpus cavernosum, CS = corpus spongiosum.
|
|
View larger version (116K):
[in a new window]
|
Figure 4c. Intracavernosal hematoma without tear of the tunica albuginea. (a) Axial T1-weighted MR image demonstrates a small, round hematoma with high signal intensity in the left corpus cavernosum (*). (b, c) On axial (b) and sagittal (c) T2-weighted MR images, the hematoma appears isointense relative to surrounding tissue. Note the intact, low-signal-intensity tunica albuginea (arrow). CC = corpus cavernosum, CS = corpus spongiosum.
|
|
View larger version (120K):
[in a new window]
|
Figure 5a. Extratunical hematoma without tear of the tunica albuginea. Axial (a) and sagittal (b) T2-weighted MR images show a small, well-marginated, high-signal-intensity hematoma in the ventral aspect of the right corpus cavernosum (arrow). Note that the hematoma is located outside the intact tunica albuginea.
|
|
View larger version (116K):
[in a new window]
|
Figure 5b. Extratunical hematoma without tear of the tunica albuginea. Axial (a) and sagittal (b) T2-weighted MR images show a small, well-marginated, high-signal-intensity hematoma in the ventral aspect of the right corpus cavernosum (arrow). Note that the hematoma is located outside the intact tunica albuginea.
|
|
View larger version (79K):
[in a new window]
|
Figure 6a. Transverse tear of the tunica albuginea. Coronal (a) and sagittal (b) T2-weighted MR images reveal a tear of the tunica albuginea in the ventral aspect of the right corpus cavernosum (arrow). The tear is transversely oriented, a finding that was confirmed at surgery.
|
|
View larger version (114K):
[in a new window]
|
Figure 6b. Transverse tear of the tunica albuginea. Coronal (a) and sagittal (b) T2-weighted MR images reveal a tear of the tunica albuginea in the ventral aspect of the right corpus cavernosum (arrow). The tear is transversely oriented, a finding that was confirmed at surgery.
|
|
View larger version (99K):
[in a new window]
|
Figure 7a. Longitudinal tear of the tunica albuginea. Axial (a) and sagittal (b) T2-weighted MR images show disruption of the tunica albuginea (arrows) with surrounding hematoma (H) in the ventral aspect of the right corpus cavernosum. Longitudinal tears can readily be assessed on MR images because the discontinuity is longer in the longitudinal direction than in the transverse direction.
|
|
View larger version (102K):
[in a new window]
|
Figure 7b. Longitudinal tear of the tunica albuginea. Axial (a) and sagittal (b) T2-weighted MR images show disruption of the tunica albuginea (arrows) with surrounding hematoma (H) in the ventral aspect of the right corpus cavernosum. Longitudinal tears can readily be assessed on MR images because the discontinuity is longer in the longitudinal direction than in the transverse direction.
|
|
View larger version (179K):
[in a new window]
|
Figure 8. Tunical tear with urethral rupture. Coronal T2-weighted MR image demonstrates a tunical tear in the ventral aspect of the left corpus cavernosum (arrowhead). A large hematoma adjacent to the tear (H) and disruption of the corpus spongiosum and urethra (arrow) are also clearly depicted.
|
|
View larger version (119K):
[in a new window]
|
Figure 9. Tunical tear with corpus spongiosal rupture. Coronal T2-weighted MR image shows a tear of the tunica albuginea in the ventral aspect of the right corpus cavernosum (black arrow). The resulting hematoma is seen displacing the corpus spongiosum (white arrow) and the urethra inferiorly and to the left. Surgery revealed a tear involving both the corpus cavernosum and the corpus spongiosum.
|
|
View larger version (112K):
[in a new window]
|
Figure 10a. Tunical tear with hematoma. Axial T2-weighted (a) and contrast-enhanced T1-weighted (b) MR images both clearly demonstrate disruption of the tunica albuginea (arrow). However, the extent of the hematoma (arrowheads) is more clearly seen on the T2-weighted image.
|
|
View larger version (103K):
[in a new window]
|
Figure 10b. Tunical tear with hematoma. Axial T2-weighted (a) and contrast-enhanced T1-weighted (b) MR images both clearly demonstrate disruption of the tunica albuginea (arrow). However, the extent of the hematoma (arrowheads) is more clearly seen on the T2-weighted image.
|
|
Copyright © 2000 by the Radiological Society of North America.
