Bello Journal of Medical Case Reports 2012, 6:321 http://www.jmedicalcasereports.com/content/6/1/321 Page 3 of 4 Figure 3 Sonourethrogram of penile fracture. (A) Sonourethrogram at the distal aspect of the penile shaft, showing a normal right and left corpus cavernosa and normal urethra. (B) Sonourethrogram at the proximal third of the penile shaft showing a normal right corpus cavernosum, a ruptured left corpus cavernosum with associated hematoma. On real-time imaging the urethra appears intact. This sonourethrogram was performed immediately following the penile ultrasound. The urethra was distended retrogradely by instilling normal saline via a Foley catheter placed at the fossa navicularis. erection from a thickness of 2mm in the flaccid state and is incapable of withstanding this enormous build-up of pressure in the CC [1]. Such trauma may occur during coitus with the penis slipping out of the vagina and hit- ting the pubis or the rigid perineum [1,2]. Masturbations, self-manipulations and kneading of the penis to achieve or hide an erection have also been reported to result in penile fractures [1,2]. The patient often reports a popping sound, mild to severe pain and sudden detumescence [1,2]. This is followed by swelling of the penis, which may involve the scrotum and or the lower abdominal wall depending on the integrity or otherwise of the Buck’s fascia. Physical examination typically reveals swelling and bruising of the penis (egg plant deformity), deviation of the penis from the side of rupture and palpable subdartos hematoma (rolling sign) [1]. A clinical diagnosis can often be easily made with the typical history and physical examination findings described [3]. The patient may, however, present atypically, reporting no preceding traumatic events and or no pain, no popping sounds or swellings and physical examination findings may be unremarkable or confusing [5,6]. Patients with urethral injury may additionally give a history of bleeding per urethra, difficulty with or inability to micturate and, in those presenting late, signs of urin- ary extravasation may be observed [7-9]. Our patient gave a history of difficulty with voiding and increased fre- quency of micturition, which led to the clinical suspicion of an associated urethral injury. Radiologic evaluations have been described for patients with penile fracture and these include retrograde urethrography, cavernosography, magnetic resonance imaging (MRI), penile ultrasound and sonourethrography [5-9]. Retrograde urethrography and cavernosography are invasive, and significant false negative findings have been reported, while MRI is an excellent imaging modality but expensive and not widely available [7-10]. Penile ultrasound is simple, non-invasive and useful in detecting the site and side of rupture in the TA and the associated hematoma while sonourethrography may show a hematoma of the corpus spongiosum and/or extravasation of fluid media (used in distending the urethra), which are indicative of urethral injury [6,9]. While we found no study describing the sensitivity or specificity of these sonographic evaluations in penile fracture, sonourethrography for urethral injury following coital trauma has been described and was able to detect a hematoma in the corpus spongiosum of the penile urethra, identifying an injury which was missed by both retrograde urethrography and penile ultrasonography (performed without urethral distension) [10]. This sug- gests sonourethrography may be useful in diagnosis of penile fractures with suspected urethral injury. Our patient had both penile ultrasound and sonoure- thrography performed in the same sitting about an hour after presentation to the emergency unit. This was a sim- ple, non-time-consuming procedure, and inexpensive at a cost of US$7. It identified the area of tear in the TA with the associated hematoma and ruled out urethral injury as there was no evidence of hematoma seen in the corpus spongiosum or extravasation of the fluid used in distending the urethra during real-time sonourethro- graphy. Our patient additionally had retrograde ure- thrography, which also revealed no urethral injury but