EURORAD ESR

Case 13598

Penile trauma - Corpus spongiosum tear

Author(s)
Prat-Matifoll JA, Ng Wong YK, Juárez M, Delgado I, Hernández Morales D, Mast R, Quiroga S

Vall Hebrón Hospital,
Institut Català De La Salut,
Radiology;
Passeig Vall Hebrón 116-119
08035 Barcelona, Spain;
Email:joanalbertpratrx@gmail.com
 
Patient
male, 51 year(s)
 
 
  • Figure 1
    Active bleeding: Arterial phase
     

    Contrast extravasation within the penile bulb (yellow arrow), which is the base of the corpus spongiosum. Note the anterior extension of contrast within the corpus spongiosum (red arrows).

     
    Area of Interest: Genital / Reproductive system male; Imaging Technique: CT; Procedure: Arterial access; Special Focus: Blood;

    Yellow arrows: Non-enhanced CT showing a voluminous and slightly hypodense corpus spongiosum.

     
    Area of Interest: Interventional vascular; Imaging Technique: CT; Procedure: Embolisation; Special Focus: Acute;
     
     
  • Figure 2
    Active bleeding: Venous phase

    Contrast extravasation in the penile bulb (yellow arrow) and anterior extension within the corpus spongiosum (red arrows). Extravasated contrast show an increased size as well as a different morphology, suggesting...

     
    Area of Interest: Genital / Reproductive system male; Imaging Technique: CT; Procedure: Arterial access; Special Focus: Acute;
     
     
  • Figure 3
    Coronal CT

    Coronal view: - Yellow arrows: Penile bulb / - Red arrows: anterior extension of contrast within corpus spongiosum / - Orange arrow: Urethral extension of contrast. Normal penile anatomy: Corpus cavernosus (green...

     
    Area of Interest: Genital / Reproductive system male; Imaging Technique: CT; Procedure: Arterial access; Special Focus: Acute;
     
     
  • Figure 4
    Angiography: First embolisation - Left
     

    Red arrow: Introducer; Green arrow: Diagnostic catheter; Yellow arrow: Left internal pudendal artery contrast blush.

     
    Area of Interest: Genital / Reproductive system male; Imaging Technique: CT; Procedure: Angioscopy; Special Focus: Acute;

    Note the contrast extravasation from the left internal pudendal artery (red arrow). After using absorbable haemostatic gelatin sponge, active bleeding was interrupted (blue arrow).

     
    Area of Interest: Abdominal wall; Imaging Technique: Lymphography; Procedure: Abscess delineation; Special Focus: Acute;
     
     
  • Figure 5
    Angiography: First embolisation- Right

    At the same time, contrast extravasation from the right internal pudendal artery was observed (red arrow) and the use of absorbable gelatin sponge was required (green arrow). Active bleeding was interrupted (blue...

     
    Area of Interest: Anatomy; Imaging Technique: Digital radiography; Procedure: Acceptance testing; Special Focus: Abscess;
     
     
  • Figure 6
    Angiography: Second embolisation
     

    After a few minutes, a new focus of contrast extravasation originating in the right internal pudendal artery was observed (red arrow). A selective angiography was performed using a micro-catheter (green arrow),...

     
    Area of Interest: Abdomen; Imaging Technique: Catheter arteriography; Procedure: Arterial access; Special Focus: Embolism / Thrombosis;

    A liquid embolic agent (red arrow, Onyx) was injected through a micro-catheter. Blue arrow: gauze pad.

     
    Area of Interest: Abdomen; Imaging Technique: Catheter arteriography; Procedure: Angioscopy; Special Focus: Acute;

    At the same time, another focus of contrast extravasation originating in the left pudendal artery was also observed (red arrow) and required the use of a liquid embolic agent (blue arrow, Onyx).

     
    Area of Interest: Abdomen; Imaging Technique: Catheter arteriography; Procedure: Angioscopy; Special Focus: Acute;
     
     
  • Figure 7
    Pelvic plain film

    After the procedure, a pelvic plain film was performed. Note the presence of bilateral liquid embolic agent (Onyx) in both internal pudendal arteries.

     
    Area of Interest: Abdomen; Imaging Technique: Catheter arteriography; Procedure: Arterial access; Special Focus: Acute;
     
     
  • Figure 8
    Antegrade and retrograde cystourethrogram
     

    Green arrow: Suprapubic catheter used to perform an antegrade cystourethrogram. Blue arrow: Foley catheter tip in the anterior urethra (penile segment) with an inflated balloon at the end, to prevent contrast reflux.

     
    Area of Interest: Genital / Reproductive system male; Imaging Technique: Percutaneous; Procedure: Cystography / Uretrography; Special Focus: Trauma;

    Note the stricture in membranous urethra, probably caused by the previous traumatic injury or the ischemic injury of embolisation (yellow arrows).

     
    Area of Interest: Genital / Reproductive system male; Imaging Technique: CT; Procedure: Angioscopy; Special Focus: Acute;
     
     
Contrast extravasation within the penile bulb (yellow arrow), which is the base of the corpus spongiosum. Note the anterior extension of contrast within the corpus spongiosum (red arrows).
 
Yellow arrows: Non-enhanced CT showing a voluminous and slightly hypodense corpus spongiosum.
 
Contrast extravasation in the penile bulb (yellow arrow) and anterior extension within the corpus spongiosum (red arrows). Extravasated contrast show an increased size as well as a different morphology, suggesting active bleeding.
 
Coronal view: - Yellow arrows: Penile bulb / - Red arrows: anterior extension of contrast within corpus spongiosum / - Orange arrow: Urethral extension of contrast. Normal penile anatomy: Corpus cavernosus (green arrows), corpus spongisoum (black arrow).
 
Red arrow: Introducer; Green arrow: Diagnostic catheter; Yellow arrow: Left internal pudendal artery contrast blush.
 
Note the contrast extravasation from the left internal pudendal artery (red arrow). After using absorbable haemostatic gelatin sponge, active bleeding was interrupted (blue arrow).
 
At the same time, contrast extravasation from the right internal pudendal artery was observed (red arrow) and the use of absorbable gelatin sponge was required (green arrow). Active bleeding was interrupted (blue arrow).
 
After a few minutes, a new focus of contrast extravasation originating in the right internal pudendal artery was observed (red arrow). A selective angiography was performed using a micro-catheter (green arrow), confirming the bleeding.
 
A liquid embolic agent (red arrow, Onyx) was injected through a micro-catheter. Blue arrow: gauze pad.
 
At the same time, another focus of contrast extravasation originating in the left pudendal artery was also observed (red arrow) and required the use of a liquid embolic agent (blue arrow, Onyx).
 
After the procedure, a pelvic plain film was performed. Note the presence of bilateral liquid embolic agent (Onyx) in both internal pudendal arteries.
 
Green arrow: Suprapubic catheter used to perform an antegrade cystourethrogram. Blue arrow: Foley catheter tip in the anterior urethra (penile segment) with an inflated balloon at the end, to prevent contrast reflux.
 
Note the stricture in membranous urethra, probably caused by the previous traumatic injury or the ischemic injury of embolisation (yellow arrows).
 
 
 
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