Cavernosal Hematoma-MRI

 Adult Male with history of coitus injury of 10 days duration ,with Ultrasound suggesting cavernosal bleed , shows on MRI, symmetrical , relatively well defined , focal hematoma(bright on T2 and Blooming on Gradient ) with no break in tunica with cavernosal arteries flow voids as well as urethra apparently normal ,consistent with caverosal haematoma. Trauma can occur in vigorous coitus. Penile fractures can be identified by breaks in tunica albuginea with surrounding hematoma.

Teaching points by Dr MGK Murthy, Dr Sumer Sethi

Relevant Anatomy : Three basic cylinders (two paired dorsal corpora cavernosa (CC)(connected to each other via fenestrations across the septum) and one ventral corpora spongiosum (CS)of intermediate signal on T1 and Bright on T2. CS arises from bulbous spongiosum in the perineum and extends anteriorly to form glans penis. Posterior attachment of CC to ischioubic rami called crura CC and CS surrounded by low signal tunica albuginea. Second fibrous layer Bucks fascia surrounds CC only to separate from CS External to Bucks is Connective tissue with T2 Bright. Superficial to connective tissue is low signal Tunica dartos which is covered by T2 Bright epidermis of Skin. Anterior urethra seen with in CS with muscular layer seen as T1 low

Technique: Patient supine with towel folded between thighs to elevate scrotal sacs and dorsiflex penis and tape it to lower abdomen to avoid movement artifacts. Surface coil, high strength MRI with axial, coronal and sagittal acquisitons. Useful in Trauma, impotency, tumours, peyronies disease, urethral injuries and others. For impotency study, inject prostaglandin E1 in to CC-10 micorgrams (Contraindication- sickle cell, cavernosal thrombosis, leukemia, myeloma, tumours etc to avoid priapism)