Ultrasound
Uroradiology & genital male imaging
Case TypeClinical Case
Authors
Nguyễn Nguyên Vũ
Patient65 years, male
A 65-year-old male patient, known as high sexual activity life, has been reporting a gradual shift of his penis towards the left by approximately 30 degrees during an erection. Physical examination proves a painless plaque measuring approximately 1 x 2cm on the haft lower dorsal section of the penis.
The ultrasound shows a thickened plaque situated on the dorsal aspect of the penis affecting the left tunica albuginea. The plaque measures 22 x 6 x 9 mm and appears hyperechogenic on B-mode, and no vascular signal is on Doppler colour (Figures 1a, 1b and 1c).
MRI images show abnormal signals of the lower left tunica albuginea, which appears hypointense on T2, T2 FS, T1, and T1 FS imaging, with non-sign of restriction on diffusion, and with slight traction around the area suggestive of fibrotic nature (Figures 2a, 2b, 2c, 2d, 2e, 2f and 2g).
Background
Peyronie’s disease is the most common cause of curvature of the penis during erection. Penile deformity and shortening are due to the development of fibrous tissue plaques in the tunica albuginea.
Diagnostic criteria are derived from the patient’s medical history and a clinical examination, including plaque palpation [1]. Causes unknown, with the hypothesis of genetic predisposition, trauma of the penis and systemic vascular diseases [2]. Penile deformities are disabling (greater than 30 degrees) in 62.5% of cases. Risk factors, such as ageing stages, smoking, alcohol consumption, abnormalities in serum lipids, diabetes, and hypertension, might have an important impact on the intensity of symptoms and the potential outcome. Peyronie’s disease is progressive in 30.2% of patients without treatment, and spontaneous resolution is uncommon [3–6].
Imaging Perspective
Ultrasound revealed localised or diffuse regions where thickened tunica albuginea is present with 100% sensitivity for gross calcifications [1].
MRI imaging is useful for demonstrating plaque extension and their relationships with adjacent structures. Plaques appear on T1 and T2-weighted imaging as thickened and irregular low-signal-intensity areas in and around the tunica albuginea, while T2-weighted images show the most detail [1].
Outcome
The operation included plaque removal, and a saphenous vein graft was used to repair the defect in the corpus cavernosa (Figures 3a and 3b). More procedures were performed to correct the penile curvature and contractions. The surgery was successful without any complications.
Eleven days after the operation, the patient appeared with positive overall assessment findings. The penile area showed no signs of oedema or fluid accumulation. The corpora cavernosa defect, which was repaired with a saphenous vein graft (*), was mending and integrating well, with no problems reported (Figures 4a and 4b).
Take Home Message / Teaching Points
History and clinical examination often lead to a correct diagnosis of Peyronie’s disease, the primary cause of penile curvature. A commonly occurring cause of Peyronie’s disease is the recurrent minor injury to the penis, especially during sexual intercourse. Repeated recurrent micro-injuries can cause localised inflammation and scar tissue development in the tunica albuginea. Ultrasound and MRI imaging play an important role in diagnosing tunica albuginea thickening. Plaque excision and grafting are needed to correct penile curvature.
[1] Bertolotto M, Pavlica P, Serafini G, Quaia E, Zappetti R (2009) Painful penile induration: imaging findings and management. Radiographics 29(2):477-93. doi: 10.1148/rg.292085117. (PMID: 19325060)
[2] Bjekic MD, Vlajinac HD, Sipetic SB, Marinkovic JM (2006) Risk factors for Peyronie's disease: a case-control study. BJU Int 97(3):570-4. doi: 10.1111/j.1464-410X.2006.05969.x. (PMID: 16469028)
[3] Kadioglu A, Tefekli A, Erol B, Oktar T, Tunc M, Tellaloglu S (2002) A retrospective review of 307 men with Peyronie's disease. J Urol 168(3):1075-9. doi: 10.1016/S0022-5347(05)64578-8. (PMID: 12187226)
[4] Mulhall JP, Creech SD, Boorjian SA, Ghaly S, Kim ED, Moty A, Davis R, Hellstrom W (2004) Subjective and objective analysis of the prevalence of Peyronie's disease in a population of men presenting for prostate cancer screening. J Urol 171(6 Pt 1):2350-3. doi: 10.1097/01.ju.0000127744.18878.f1. (PMID: 15126819)
[5] Schwarzer U, Sommer F, Klotz T, Braun M, Reifenrath B, Engelmann U (2001) The prevalence of Peyronie's disease: results of a large survey. BJU Int 88(7):727-30. doi: 10.1046/j.1464-4096.2001.02436.x. (PMID: 11890244)
[6] Levine LA, Larsen SM (2013) Surgery for Peyronie's disease. Asian J Androl 15(1):27-34. doi: 10.1038/aja.2012.92. (PMID: 23178395)
URL: | https://eurorad.org/case/18693 |
DOI: | 10.35100/eurorad/case.18693 |
ISSN: | 1563-4086 |
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