A sonographic pitfall in penile fracture: Spongiosal displacement mimicking urethral injury, with surgical correlation

Penile fracture is a urological emergency in which high-resolution ultrasound can help localize tunical disruption and define associated soft-tissue injury. We report a 40-year-old man who sustained penile fracture during intercourse in the female-superior position. High-resolution ultrasound with color Doppler (Voluson E8, 12–15 MHz linear transducer) identified a tunical defect at the mid third of the dorsal surface of the left corpus cavernosum, measuring 7.8 × 2.6 mm, with an intracavernosal hematoma measuring 33.9 × 21.7 × 32.0 mm and causing marked lateral displacement of the corpus spongiosum. Because this displacement raised concern for associated urethral injury, the urethra and corpus spongiosum were assessed in multiple transverse and longitudinal planes. Preserved spongiosal echotexture, visualized continuity of the urethral course, absence of perispongiosal fluid, and preserved Doppler perfusion supported preservation of urethral integrity. Same-day surgical exploration confirmed the tunical tear, intact corpus spongiosum and urethra, and hematoma containment within Buck’s fascia. No MRI, retrograde urethrography, or cystoscopy was required in this clinically concordant case. This case illustrates how hematoma-related spongiosal displacement may mimic urethral injury and shows the complementary value of systematic multiplanar ultrasound in pre-operative assessment. Additional urethral imaging or endoscopic evaluation remains appropriate when clinical or sonographic suspicion persists.