Bello Journal of Medical Case Reports 2012, 6:321 http://www.jmedicalcasereports.com/content/6/1/321 C A S E R E P O R T JOURNAL OF MEDICAL CASE REPORTS Open Access Synergism of clinical evaluation and penile sonographic imaging in diagnosis of penile fracture: a case report Jibril Oyekunle Bello Abstract Introduction: Penile fracture is an uncommon urologic emergency, and is the traumatic rupture of the tunica albuginea covering the corpus cavernosa. This usually occurs following blunt trauma sustained during coitus, masturbation or self-manipulations to hide or suppress an erection. Clinical diagnosis can often be easily made with typical history and examination findings. However, the patient may present atypically and/or with a suspicion of associated urethral injury. The roles of various diagnostic investigations are being evaluated in these situations. Case presentation: We report the case of a 31-year-old African man with penile fracture and suspected associated urethral injury that occurred after self-manipulations to hide an erection. Conclusions: Penile ultrasound and sonourethrography provide useful additional diagnostic information to supplement clinical history and physical examination findings and can be performed easily, at low cost and with no delays to surgery. Keywords: Tunica Albuginea, Corpus Cavernosum, Penile fracture, Penile Ultrasound, Sonourethrography Introduction Penile fracture is an uncommon urologic emergency, and is the traumatic rupture of the tunica albuginea (TA) covering the corpus cavernosum (CC). It results when blunt trauma to the erect penis results in a rapid build- up of pressure in the engorged CC, which overwhelms the tensile strength of the TA; this often follows trauma during coitus, masturbation or self-manipulations to hide or suppress an erection [1,2]. Several reports have cast doubts on the value of diagnostic investigations, with some asserting that penile fracture is a clinical diagnosis and others concluding that the investigations add to treatment costs and delays to surgery [2-4]. However, the roles of the various diagnostic investigations are still being evaluated. We report a case of penile fracture with suspected associated urethral injury that had both clinical assessment and inexpensive radiologic evaluations, which together were helpful in making a definitive diagnosis with no delay of surgery. Correspondence: jabarng@yahoo.com Urology unit, Department of Surgery, University of Ilorin Teaching Hospital, Ilorin, Nigeria Case presentation A 31-year-old African man presented to our emergency unit with a four-hour history of penile swelling and void- ing difficulty. He had earlier tried to suppress an erection before his routine morning religious rituals by knead- ing on his erect penis. He heard a popping sound with associated minimal pain and sudden detumescence. He noticed no bleeding per urethra but subsequently had difficulty with voiding and urinary frequency. On phys- ical examination, he had a grossly swollen and deformed penis with deviation to the right side (Figure 1). A diag- nosis of penile fracture with probable associated urethral injury was made. Bedside urine analysis results were negative for blood and he was taken for penile ultrasound and sonourethrography about an hour after presentation to the emergency unit. This was performed using a high-frequency 7.5MHz transducer with our patient in a supine position and the penis supported with towels be- tween the thighs. A generous amount of sonographic acoustic gel was applied on the dorsum of the penis and images were obtained both in longitudinal and transverse planes beginning at the glans and proceeding proximally to the root of the penis. This was performed initially © 2012 Bello; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.