Imaging abdomen trauma male geniital part 10 dr ahmed esawy include different cases for oral radiodiagnosis examination all over the world CT /MRI Plain X ray images blunt abdominal trauma penetrating abdominal trauma fast abdominal ultrasound haemoperitoneum pneumoperitoneum american association of surgeon in trauma AAST SUBCAPSULAR HAEMATOMA PARENCHYMAL LACERATION TESTICULAR RUPTURE TESTICULAR CONTUSION HAEMATOCELE PYOCELE PENILE TRAUMA RUPTURE PENIS

2. An Article By
Dr. Ahmed Esawy
MBBS M.Sc MD

4. Testicular Trauma
Tunica albuginea can withstand 50kg
pressure before rupture
Immediate exploration: gross rupture on
pe, large hematocoele, testicular
dislocation
Ultrasound is secondary adjunct only!
High rate of testicular loss when exploration
delayed
U/S can miss rupture

5. GRADE
I Contusion/hematoma
II Subclinical laceration of tunica albuginea
III Laceration of tunica albuginea with <50%
parenchymal loss
IV Major laceration of tunica albuginea with >50%
parenchymal loss
V T otal testicular destruction or avulsion

6. Longitudinal ultrasonogram of the left testis reveals multiple hypoechoic areas in the
inferior pole, consistent with a contusion injury, secondary to gunshot wound.

7. Transverse ultrasonogram of both testes demonstrates variable echo texture in
the scrotal wall secondary to hemorrhage resulting from a motor vehicle
accident.

8. Hematocele

9. esticular rupture is seen as focal alterations of
testicular echogenicity correlating with areas of
intratesticular hemorrhage or infarction in a patient
with a hematocele.

10. Testicular fracture. Longitudinal color Doppler US image in a patient with
scrotal trauma depicts a hypoechoic avascular band (arrows) that crosses the testicular
parenchyma.

11. Intratesticular hematoma. Transverse color Doppler US image in a patient with scrotal
trauma demonstrates an avascular hypoechoic area (arrow) within the testis. The
hematoma was managed conservatively.

12. Injured testis appear inhomogenous
disorganised and with indistincit outline

13. Testicular Hematoma

14. Testis laceration

15. Left testis in inguinal canal

16. Pathogenesis:
The tunica albuginea thins during erection is susceptible to
injury.
 Sudden direct force on the dorsum can often lead to fracture.
 In most cases, a tear occurs in only one of the corpora cavernosa
and its surrounding tunica albuginea.
 The corpus spongiosum and the urethra can also be involved.
Clinical manifestation:
An audible crack
Sudden onset of pain,
Immediate loss of erection,
Rapid swelling and widespread ecchymosis.
Deviation toward the side opposite the injury are characteristic .
hematoma is usually confined to the penis but can extend to the
scrotum, perineum, and thighs.
Hematuria or dysuria may be present
Penile Trauma

17. External Genital Trauma
Penile Trauma

18. Injury severity scale for the penis
Grading
1 Cutaneous laceration/contusion
2 Buck’s fascia (cavernosum) laceration without tissue loss
3 Cutaneous avulsion/laceration through glans/meatus/cavernosal or urethral
defect < 2 cm
4 Cavernosal or urethral defect > 2 cm/partial penectomy
5 Total penectomy

19. Penile Fracture: Injury of the Penis Corpora
Traumatic rupture of the corpora of the penis during erection is called a penile fracture
Penile fracture usually arises from a bending trauma during
vigorous sexual intercourse, especially when the penis slips out of
the vagina. Furthermore, penile fractures are caused by
masturbation practices with bending of the penile shaft
during erection (practice of taghaandan).

20. Transverse fracture of
tunica albuginea is seen
with fracture extending
through right corpora
cavernosa, and collection
beneath the Buck's fascia.
Marked surrounding
edema in penis is seen.
AXIAL,CORONAL T2

21. A) Sagital view of MRI
showing rupture in the
tunica albuginea
(arrow).
B) Frontal view of the
same patient showing
disruption in the tunica
albuginea of the corpus
cavernosum (circle).

22. MRI of a penile fracture (on the left horizontal and on
the right frontal recontructions): the defect is visible
at the right corpus cavernosum.

23. Sonographic Evaluation of Penile Trauma
Normal penis.
A, Transverse gray scale sonogram
of the penis shows the 2 corpora
cavernosa (CC) surrounded by the
tunica
albuginea (arrowhead). The corpus
spongiosum (CS) is shown inferior
to the corpora cavernosa. All 3
corpora are surrounded by
Buck’s fascia (arrow).
B, Longitudinal color flow image of
the normal penis shows the
cavernosal artery (arrow) with its
helicine branches
(arrowheads) radiating into the
corpus.

24. Penile Fracture (Corpus Cavernosal and Tunica Albugineal Rupture)
Penile injury after sexual
intercourse in a 27-year-old man.
A, Longitudinal gray scale
sonogram of the penis shows a
hypoechoic
area near the base of the penis
anterior to the right corpora
cavernosa (arrow).
B, Transverse gray scale sonogram
slightly caudal
to the longitudinal image reveals a
large, irregularly defined
hyperechoic area (asterisk). No
corpus cavernosa can be identified
at this level, and this is consistent
with a 2-cm-long corpus cavernosal
tear, which was subsequently
confirmed at surgery. There was no
associated urethral rupture in this
case.

25. Fracture of the penis in a 24-year-old man. After
sexual activity, the patient had loss of penile rigidity,
pain, and hematuria.
.
C, Retrograde urethrogram reveals
associated rupture of the bulbar urethra
(arrow). The patient subsequently
underwent surgical exploration and repair
B, Corresponding color flow image shows
an absence of color flow within the area of
the penile fracture.
A, Transverse gray scale sonogram of the
penis shows subcutaneous hematoma of
variable echo texture in continuity with the
right corpus cavernosa, suggesting a break
in the continuity of the tunica albuginea
(asterisk). This appearance
suggests a penile fracture. The Foley
catheter is within the urethra (arrow).

26. Intracavernosal hematoma after sexual intercourse in a 28-year-
old man. Transverse gray scale sonograms of both corpora
cavernosa (asterisks) reveal a hyperechoic area (arrow) on the
medial aspect of the left corpus cavernosa (right), suggestive of a
cavernosal hematoma. This resolved on follow-up within 2 weeks.
The right corpus (left) is normal.

27. High-flow priapism in a 27-year-
old man. The patient injured his
penile shaft while riding a bull 15
days before admission.
The patient had a painless
persistent erection.
A, Longitudinal color flow
sonogram of the penis shows an
area of color flow aliasing (arrow)
within the left corpus cavernosum
near the tip of the penis. This is
consistent with the presence of
an arterial-lacunar fistula.
B, Corresponding color flow
Doppler image with spectral
tracing reveals marked turbulence
of blood flow, thereby confirming
the arterial-lacunar fistula

28. Penile hematoma due to
avulsion of dorsal penile
vessels in a 32-year-old man.
A, Transverse gray scale
sonogram of the penis reveals
a hypoechoic area (arrow)
anterior to the tunica
albuginea suggestive of a
penile hematoma. The
corpora
cavernosa (asterisk) and the
tunica albuginea (arrowhead)
are intact.
B, Corresponding longitudinal
gray scale sonogram further
confirms this finding (arrow).

29. THANK YOU