Urgent-setting magnetic resonance imaging allows triage of extensive penoscrotal hematoma following blunt trauma
A healthy 40-year-old male arrived to Emergency Department after a bicycle fall. At physical examination, the most prominent finding was a painful, extensive ecchymosis and hematoma involving the penis and ventral aspect of the scrotum. The patient urinated without difficulty, macroscopic hematuria was absent and urinalysis excluded significant abnormalities.\nPlain radiographs of the pelvic skeleton (not shown) did not disclose bony fractures. In consideration of the association of an atypical history of trauma on a flaccid penis associated with extensive regional hematoma and marked tenderness, the attending Urologist requested emergency magnetic resonance imaging (MRI) to be performed, including focused multiplanar T1-, STIR and T2-weighted sequences acquired with the penis in a neutral position []. A diffuse, subcircumferential T1- and T2-hyperintense subacute hematoma involved the superficial skin and subcutaneous planes of the entire penis, perineal region and anterior aspect of the scrotum. The low-signal tunica albuginea was recognizable along the penile shaft, without appreciable discontinuities suggesting a possible penile fracture. No signs of hematoma were noted in the spongiosum and cavernosal bodies. The testes (as confirmed by ultrasound, not shown) showed normal size and shape, homogeneous signal intensities and good visualization of their tunica albuginea. The absence of signs of penile and testicular rupture led to conservative treatment option, with resolution of clinical abnormalities after two weeks and no functional complaints.