not it! jenelle beadle 2/1/2016. segmental anatomy
DESCRIPTION
Orientation Prox DistTRANSCRIPT
PENILE ULTRASOUNDNot It!
Jenelle Beadle2/1/2016
Segmental Anatomy
Orientation
Prox
Dist
Orientation
Dorsal
Ventral
Cavernosa = DorsalSpongiosum = Ventral
Psst! It’s pronounced alb-you-jin-ee-uh
Fascial Layers
Tunica Albuginea Thickness• Flacid: 1-2 mm• Erect: 0.25-0.5mm
Tunica Albuginea Thickness• Flacid: 1-2 mm• Erect: 0.25-0.5mm
Tunica Albuginea Thickness• Flacid: 1-2 mm• Erect: 0.25-0.5mm
MRI• better visualization of
anatomy
Ultrasound• cheaper• evaluate blood flow with
Doppler
Acute Indications & Findings
Trauma Pain Erection
Fracture X XLow Flow Priapism X XHigh Flow Priapism X X
PriapismLOW FLOW PRIAPISM(ISCHEMIC)
HIGH FLOW PRIAPISM(NON-ISCHEMIC)
outflow obstruction idiopathic drug related
more common sustained rigid erection
(glans spared) painful emergency
stagnation leads to ischemic corpora
often presents within hours
increased inflow AV fistula (trauma) no outflow obstruction
less common sustained partial
erection painless non-emergent
well oxygenated corpora
may take days to weeks to present
Penile Fracture Tear in the tunica albuginea
disrupted tunica with associated hematoma hx of trauma immediate detumescence painful swelling discoloration
Penile Fracture
Long
Trans
Penile Fracture
Long
Trans
C
C S
Penile Fracture
LongTrans
Penile Fracture
LongTrans
C
CS
Penile Fracture - MRI
Penile Fracture - MRI
Chronic Indications palpable abnormality focal tenderness abnormal curvature
Chronic Indications palpable abnormality focal tenderness abnormal curvature
Most common finding:Peyronie’s Disease
Peyronie’s Disease Cause is not
completely understood trauma, meds, diabetes
Scarring of the tunica albuginea dorsal (most common),
ventral and septal originates immediately
deep to the tunica albuginea
Ultrasound Findings Focal thickening
typically linear and calcified with shadowing echogenic, isoechoic, hypoechoic
Scarring is not elastic• Results in
curvature during erection
• towards the defect
Honorable Mention: Mondor Disease
Thrombophlebitis of the superficial dorsal vein cord-like palpable
abnormality painful
Self limiting treated like any other
superficial thrombophlebitis warm compress Anticoagulants
Same name when it occurs in the chest wall
Scanning Protocol No written protocol Scheduled as an extremity with rad time
ER and outpatient we do not schedule these for erectile
dysfunction Any sonographer expected to scan Any body radiologist expected to read
radiologist must be given the opportunity to scan
Most important structure to evaluate is the tunica albuginea must be examined from multiple approaches
• Dorsal • Parasagittal
• Ventral • Parasagittal &
Midline• Coronal
• Rt & Lt Lateral
Ultrasound examination requires multiple approaches:
Ultrasound examination requires multiple approaches:
• Dorsal • Parasagittal
• Ventral • Parasagittal &
Midline• Coronal
• Rt & Lt Lateral
Ultrasound examination requires multiple approaches:
• Dorsal • Parasagittal
• Ventral • Parasagittal &
Midline• Coronal
• Rt & Lt Lateral
Suggested Protocol Dorsal (3 images, 1 cine)
Long Rt & Lt Cavernosum Trans Cavernosa Trans Dorsal Cine Prox-Dist
Coronal – Rt & Lt (2 images) Long Lateral Rt Cavernosum Long Lateral Lt Cavernosum
Ventral (2 images, 1 cine) Long Spongiosum Trans Spongiosum Trans Ventral Cine Prox-Dist
Area of concern Additional images as necessary to evaluate
pathology be as specific as possible when describing location