Penile Emergencies–Demystifying the Sonographic Spectrum

Penile emergencies are uncommon and can be categorized as having infectious, vascular, traumatic, or multifactorial etiologies. To facilitate early diagnosis and treatment during emergency, US and color Doppler imaging are imperative. US depicts hypoechoic collections regardless of the presence of air foci in infections like abscess and Fournier’s gangrene. Color Doppler imaging is conducted to evaluate vascular conditions such as penile Mondor disease (PMD) and priapism. PMD is indicated by the absence of color flow and non-compressibility of dorsal penile vein. Priapism can be categorized based on cavernosal artery flow: high flow and low flow. In traumatic injuries like penile fracture, US reveals breach in tunica albuginea with hematoma. Peyronie’s disease can be multifactorial in origin and the imaging is commonly visualized as thickening of the tunica albuginea and echogenic calcified plaques. Urethral injuries are urethral discontinuity with adjacent collection. Urethral calculus is visualized as echogenic focus with posterior acoustic shadowing. Therefore, effective collaboration between radiologists and urologists is required for appropriate initial diagnosis and prompt treatment.