G e n i t o u r i n a r y I m a g i n g • R ev i ew

Nicola et al.
Scrotal and Penile Trauma

Genitourinary Imaging
Review
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FOCUS ON:

Imaging of Traumatic Injuries to

the Scrotum and Penis
Refky Nicola1 OBJECTIVE. The purpose of this article is to review scrotal and penile anatomy, the role
Nancy Carson of ultrasound in evaluating scrotal and penile trauma, and the vast spectrum of sonographic
Vikram S. Dogra manifestations of scrotal and penile trauma.
CONCLUSION. Scrotal and penile trauma is an uncommon type of trauma injury.
Nicola R, Carson N, Dogra VS However, knowledge of scrotal and penile anatomy and the appropriate imaging findings as-
sociated with acute traumatic injuries is important in establishing the correct diagnosis. So-
nography is considered the first choice of imaging modalities in establishing a diagnosis and
triaging patients into surgical and nonsurgical treatment.

Keywords: Doppler, penis, scrotum, testis, trauma,
ultrasound
DOI:10.2214/AJR.13.11676
Received August 5, 2013; accepted after revision
September 20, 2013.
Presented at the 2013 annual meeting of the ARRS,
Washington DC.
1
All authors: Department of Radiology, University of
Rochester Medical Center, 601 Elmwood Ave, PO Box
648, Rochester, NY 14642. Address correspondence to
V. S. Dogra (vikram_dogra@urmc.rochester.edu).  With these injuries, delay in diagnosis and
This article is available for credit.
WEB
This is a web exclusive article.
AJR 2014; 202:W512–W520
0361–803X/14/2026–W512
© American Roentgen Ray Society
S
crotal and penile trauma is an
uncommon type of trauma inju-
ry, but prompt diagnosis is essen-
tial in the triage of patients with
these injuries. Mechanisms of scrotal trauma
include blunt, penetrating, and degloving in-
juries. More than one half of testicular inju-
ries are caused by blunt trauma. Blunt trau-
ma from being struck in the groin during
athletic activity is the most common type.
Blunt trauma due to motor vehicle collisions
and assault accounts for only 9–17% of cases
of blunt trauma [1]. Other mechanisms of
trauma, such as penetrating, thermal (i.e.,
burns), and degloving injuries, are less com-
mon. Penetrating trauma is caused by gun-
shots (most common), stabbing, animal at-
tack, and even self-mutilation. Thermal and
degloving injuries are a less common form of
scrotal injuries. With a degloving injury, the
scrotal skin is sheared off, and a skin graft is
necessary for repair [2].
Most penile injuries are related to sexu-
al activity that results in penile fracture [3].
inaccurate diagnosis can result in infection,
ischemia, infarction, penile atrophy, and de-
creased fertility [4–7].
High-frequency ultrasound with a linear
transducer and gray-scale, color, and spectral
Doppler flow technique is the primary nonin-
vasive modality for establishing an accurate
diagnosis. It is used to assess the anatomic
and physiologic integrity of the area and ob-
tain high-resolution images. The advantage
of ultrasound is that it is readily available,
inexpensive, portable, and can be performed
without patient preparation [8–10].
This article reviews scrotal and penile
anatomy, the role of ultrasound in evaluating
scrotal and penile trauma, and the vast spec-
trum of sonographic manifestations of scro-
tal and penile trauma.
Scrotal Anatomy
The scrotum is divided by the midline sep-
tum, which is also referred to as the median
raphe. Each half of the scrotum contains a
spermatic cord, testis, and epididymis. The
scrotal wall consists of the following lay-
ers from superficial to deep: rugated skin,
superficial fascia, dartos muscle, external
spermatic fascia, cremasteric fascia, and in-
ternal spermatic fascia. The testes are sepa-
rated from the scrotum by the tunica vagi-
nalis, which has two layers. The layer lining
the scrotal wall is the parietal layer, and the
layer extending over the testis and epididy-
mis is the visceral layer. The tunica vaginalis
covers the testis and epididymis except for a
small area in the posterior aspect. A poten-
tial space between the visceral and parietal
layers can normally contain a few milliliters
of fluid. These two layers of the tunica vagi-
nalis join at the posterolateral aspect of the
testis, where it attaches to the scrotal wall.
The tunica albuginea is a dense fibrous
layer that lies deep to the tunica vaginalis.

W512 AJR:202, June 2014


Each testis is bound externally by the tunica
albuginea, which helps to maintain its shape
and integrity. The tunica albuginea appears
as two bright echogenic lines at high-fre-
quency sonography (Fig. 1).
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A testis measures 5 × 3 × 2 cm after puber-
ty and is homogeneously echogenic at ultra-
sound. The testicular parenchyma consists of
multiple lobules, each of which is composed
of several seminiferous tubules that lead via
tubuli recti to the dilated spaces known as
the rete testis within the mediastinum.
The epididymis, which overlies the supe-
rior and lateral aspects of the testis, is com-
posed of a head, body, and tail. The head is
a 5- to 12-mm triangular structure situated
atop the superior pole of the testis. At ultra-
sound the head is isoechoic in relation to the
testis. The body of the epididymis is 2–4 mm
thick as it courses alongside the testicle infe-
riorly to become the tail, which continues as
the vas deferens in the spermatic cord.
Sonographic Evaluation of the Scrotum
Standard ultrasound technique is performed
with the patient lying supine with the scrotum
supported by a towel between the thighs. For
optimal results, a 7–14-MHz high-frequen-
cy linear-array transducer is used, and the gel
should be warm. If the patient has an open
wound, sterile technique is recommended. Im-
mediately after trauma injury, the scrotum is
often tender to palpation, which makes scan-
ning exceptionally challenging.
A complete evaluation of the anatomy of
the scrotum should be performed even in the
acute phase, when time is limited. Trans-
Fig. 1—34-year-old man with right testicular pain.
A, Sagittal gray-scale ultrasound image of normal right testis shows homogeneous echotexture. Tunica albuginea (arrows) appears as echogenic line surrounding tes-
ticle.
B, Transverse bilateral color Doppler image shows normal symmetric blood flow.
AJR:202, June 2014 W513
Scrotal and Penile Trauma
verse images with portions of each testis in
the same image should be acquired in gray-
scale and color Doppler modes to allow op-
timal comparison (Fig. 1). Each testis is ex-
amined in at least two planes: longitudinal
and transverse. In patients being evaluated
for scrotal trauma, the asymptomatic side
should be scanned first to set the gray-scale
and color Doppler gain settings to allow
comparison with the affected side [2]. Col-
or Doppler and spectral Doppler parameters
are optimized to low velocity settings to dis-
play blood flow within the testes and the sur-
rounding structures. Pulsed Doppler record-
ings should be obtained in each testis (Fig.
2). The power Doppler mode is used to eval-
uate patients with acute scrotal pain when
minimal flow is detected with standard set-
tings. In addition to static images, cine clips
of the scrotum can be obtained for careful
scrutiny of the area after the examination.
The structures within the sac and the
scrotal skin thickness are also examined to
evaluate for extratesticular injuries or other
abnormalities, such as collections and he-
matomas. The sonographic characteristics of
scrotal trauma can be broadly classified into
intratesticular and extratesticular (epididy-
mis) and intrascrotal and extrascrotal inju-
ries (e.g., to the penis and perineum).
Intratesticular Injuries
Testicular Rupture
The normal tunica albuginea appears as
a hyperechoic line outlining the testis. The
discontinuity of the tunica albuginea sug-
gests rupture of the testis, which causes ex-
A B
trusion of the testicular parenchyma, thus ap-
pearing as a contour abnormality within the
scrotum (Fig. 3). The presence of tunica al-
buginea disruption alone has sensitivity and
specificity of 50% and 75% for testicular in-
jury [11]. Because of the rupture of the tuni-
ca albuginea, there is injury to the testicular
parenchyma, which is seen as heterogeneous
echogenicity within the testis. In addition, the
disruption of the tunica vasculosa, which un-
derlies the tunica albuginea and is composed
of capsular arteries within the testis, is an in-
direct sign of tunica albuginea rupture [12].
This results in loss of vascularity to a por-
tion of the testis. Therefore, the presence of
heterogeneous echotexture within the testis,
testicular contour abnormality due to disrup-
tion of the tunica albuginea, and regions of
avascularity have the highest sensitivity and
specificity for testicular rupture [5, 13]. He-
dayati et al. [14] described the use of contrast
material to assess for vascular flow to further
delineate vascular compromise and evaluate
the extent of viability of a ruptured testis. We
do not use this technique at our institution.
More than 80% of ruptured testes can be
salvaged if surgical repair is performed with-
in 72 hours of testicular injury [15]. Typical-
ly, testicular rupture is unilateral, but 1.5%
of cases are bilateral [16]. On rare occasions,
testicular rupture can be associated with epi-
didymal ruptures, which may at times be dif-
ficult to detect with ultrasound.
Testicular Fracture
Testicular fracture is identified at ultra-
sound by the presence of a relatively linear
 Nicola et al.

times difficult to identify because they can

appear isoechoic in relation to the surround-
ing testis or may have a diffusely heteroge-
neous echotexture. For this reason, an acute
hematoma is reexamined within 12–24 hours
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after the initial ultrasound examination to

Fig. 2—25-year-old man with right testicular pain. Sagittal color and spectral Doppler image shows normal low-
resistance arterial waveform.
hypoechoic, avascular area within the testic-
ular parenchyma that may or may not be as-
sociated with tunica albuginea rupture [17].
Actual fracture lines through the testicle are
rare in cases of testicular fracture [18]. Color
Doppler ultrasound plays an important role
in the evaluation of testicular fracture. Flow
within the testicular parenchyma is indica-
tive of salvageability. Frequently, débride-
ment is performed along the fracture line,
and the rest of the vascular parenchyma is
preserved [2, 12].
Hematoma
Intratesticular hematomas are fairly com-
mon findings in blunt testicular trauma. The
ultrasound appearance of a hematoma de-
pends on the time that has elapsed between
the trauma and the ultrasound evaluation.
Hyperacute and acute hematomas are some-
find any changes in echogenicity [12, 19].
As a hematoma evolves, it becomes more
hypoechoic to anechoic and eventually de-
creases in size. Color Doppler can be used
to differentiate such hematomas from the tu-
mors included in the differential diagnosis of
intratesticular lesions. A well-defined hema-
toma within the testis does not exhibit inter-
nal vascularity except when it is infected [12]
(Fig. 4).
In patients with hematoma, the most im-
portant role of ultrasound is to exclude tes-
ticular rupture, because the care of these pa-
tients can depend primarily on the ultrasound
findings. Small hematomas without direct
evidence of testicular rupture are managed
conservatively with ice packs, nonsteroidal
antiinflammatory drugs, follow-up physi-
cal examinations, and serial ultrasound ex-
aminations [5]. Follow-up ultrasound of all
conservatively treated intratesticular hema-
tomas until they resolve is essential because
of the high incidence of infection and ne-
crosis, which may require orchiectomy [12].
Another reason for follow-up ultrasound is
that a testicular tumor should be considered
in the differential diagnosis of intratesticular
lesions. Lesions are excluded if the area of
concern shows interval resolution [19].
It is recommended that large intratestic-
ular hematomas be surgically explored and

A B

Fig. 3—32-year-old man with scrotal rupture due to motor vehicle accident.
A, Longitudinal gray-scale ultrasound image of right testis shows disruption of tunica albuginea (straight arrow) that results in contour abnormality (asterisk) and forma-
tion of focal hematoma (curved arrow).
B, Color Doppler image shows decreased vascularity within ruptured segment of testis (arrowhead) and no vascularity in focal hematoma (arrow). Patient underwent
surgical débridement.

W514 AJR:202, June 2014


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Fig. 4—30-year-old man with testicular hematoma resulting from sports injury.
A, Longitudinal gray-scale ultrasound image of left testis shows intratesticular hypoechoic region (arrow) suggestive of intratesticular hematoma.
B, Color Doppler image shows no vascularity within hematoma (arrow).
drained even if there is no evidence of testicu-
lar rupture or large extratesticular hematocele.
The purpose is to avoid progressive pressure
necrosis, atrophy, and orchiectomy [20].
Extratesticular Injuries
Scrotal Hematoma or Hematocele
Extratesticular hematoceles, or collec-
tions of blood within the tunica vaginalis,
are the most common finding in the scrotum
after blunt trauma [12]. Micallef et al. [13]
noted such findings in 11 of 15 patients. Ex-
tratesticular soft tissues, such as the scro-
tal wall, tunica albuginea, and epididymis,
may also be involved. The ultrasound ap-
pearance of an extratesticular hematocele or
hematoma varies with the age of the lesion.
AJR:202, June 2014 W515
Scrotal and Penile Trauma
A B
Fig. 5—45-year-old man
with hematocele and
hematoma due to scrotal
trauma. Transverse gray-
scale ultrasound image
of left testis shows he-
matocele and hematoma
(asterisks) with hematocrit
levels. T = testis.
Fig. 6—47-year-old man with scrotal wall hematoma
Acute hematocele is echogenic in appear- after sports injury. Gray-scale ultrasound image
ance, whereas chronic hematocele is more shows heterogeneous scrotal wall thickening (ar-
anechoic, can develop septa and loculations, rows) secondary to hemorrhage and small hemato-
cele (arrowhead). Testis (T) is not injured.
and may not resolve [21] (Fig. 5). It may
also become calcified and mimic an extra-
testicular calcified mass. nica rupture in the presence of a large hema-
In the acute phase, a large hematocele can toma [22]. Posttraumatic hematomas can be
cause extrinsic compression on surrounding confined to the scrotal wall, where they ap-
blood vessels and reduce blood flow, resem- pear at ultrasound as focal thickening or a
bling complete or partial torsion. Therefore, fluid collection within the wall (Fig. 6).
emergency surgical evacuation of the extra-
testicular hematoma is necessary to restore Traumatic Epididymitis
blood flow and salvage the testis. A large he- Traumatic epididymitis is uncommon, but
matocele also requires surgical exploration it can occur in patients who have sustained
irrespective of evidence of tunica albuginea acute scrotal trauma. The ultrasound find-
rupture. The reason for this step is that ul- ings of traumatic epididymitis are an en-
trasound has limited utility in identifying tu- larged heterogeneous epididymal head that is

hypoechoic in relation to the testis owing to
swelling and edema. Color Doppler imaging
also shows increased flow in the epididymal
head [23] (Fig. 7). Heterogeneity of the epi-
didymal head can be secondary to hematoma
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or contusion [15, 24]. Although this appear-
ance is similar to that of infectious epididy-
mitis, the history of recent traumatic injury
suggests traumatic epididymitis. However, in-
fectious epididymitis is more common [19].
Testicular Torsion
Trauma-induced testicular torsion is a
well-known phenomenon and a surgical
emergency. Traumatic torsion can be caused
by stimulating forceful contraction of the
cremaster muscles. Both gray-scale and col-
or-flow Doppler evaluations are essential for
evaluating the alterations caused by trauma.
The sonographic characteristics of posttrau-
matic testicular torsion are similar to those
of spontaneous testicular torsion [1].
Testicular Dislocation
Testicular dislocation is uncommon af-
ter trauma injury, and it is difficult to diag-
nose with ultrasound examination after acute
trauma. Unless the sonographer or the radiol-
ogist is aware of it, testicular dislocation can
be easily missed.
Testicular dislocation is typically unilater-
al and rarely bilateral [25]. It usually occurs
in straddle injuries in motorcycle accidents
when the rider is propelled forward, and the
scrotum and perineum strike the fuel tank.
The fuel tank acts as a smooth wedge driving
into the groin area, forcibly displacing each
testis in the superolateral direction [26, 27].
Patients with a wide external inguinal ring,
an indirect inguinal hernia, or an atrophic
testis are more vulnerable to testicular dis-
W516 AJR:202, June 2014
Nicola et al.
location due to trauma [28, 29]. The dislo-
cated testis can be anywhere along the sper-
matic cord. The superficial inguinal area is
the most common site of dislocation. Other
sites such as perineal, retrovesical, and even
acetabular regions are much less common
[30, 31].
The diagnosis of testicular dislocation can
be made when palpation reveals an empty
and ecchymotic hemiscrotum and an ipsilat-
eral inguinal mass. Color-flow Doppler ultra-
sound is essential for evaluating the viability
of the testis. If the dislocated testis is viable,
manual reduction is performed. If this ma-
neuver is not successful, immediate surgical
reduction and fixation are necessary [32].
Penile Anatomy
The penis consists of a pair of corpora cav-
ernosa along its dorsal aspect and a midline
corpus spongiosum along its ventral surface.
The crura of the corpora cavernosa are at-
tached to the ischial tuberosities. The corpora
cavernosa are composed of venous sinusoids
that fill with blood during erection, and they
are surrounded by the tunica albuginea. The
corpus spongiosum surrounds the urethra and
expands anteriorly to form the glans penis; it
is also surrounded by the glans tunica albu-
ginea. The three corpora combined are sur-
rounded by two fascial layers: the superficial
Colles fascia and the deeper Buck fascia. The
tunica albuginea is the deepest fibrous layer
and surrounds each corpus individually.
On transverse images, the two corpora
cavernosa are seen as symmetric homoge-
neous midlevel-echo circular structures that
are surrounded by an echogenic line repre-
senting the tunica albuginea (Fig. 8). The
two corpora cavernosa are separated by the
septum penis, an extension of the tunica al-
A B
buginea, which appears as a thin echogenic
line. When the penis becomes erect, the two
corpora cavernosa enlarge and the sinusoids
dilate, changing the echogenicity from ho-
mogeneous to hypoechoic.
The arterial supply to the penis is from
the dorsal artery, which is lateral to the
deep dorsal vein and supplies the glans pe-
nis and skin. The cavernosal artery is a ter-
minal branch of the internal pudendal artery.
It is located within the center of the corpus
cavernosum and provides arterial flow dur-
ing erection. The urethral bulb and poste-
rior corpus spongiosum are supplied by the
bulbourethral artery, which is known as the
urethral bulb. The venous supply is through
the dorsal veins: the superficial dorsal vein,
which is superficial to the Buck fascia, and
the deep dorsal vein, which is deep to the
Buck fascia.
Sonographic Evaluation of the Penis
The standard technique for ultrasound of
the penis is performed with the patient in the
supine or lithotomy (frog-leg) position and
the penis in the anatomic position, lying on
the anterior abdominal wall. Longitudinal
and transverse gray-scale and Doppler color-
flow images of the entire length of the pe-
nis should be obtained with a high-frequen-
cy (7.5–12-MHz) linear array transducer and
acoustic gel. A transperineal approach with
elevation of the testes is used to assess the
base of the penis.
The cavernosal artery is located within the
center of the corpus cavernosum or slightly to-
ward the median septum penis and is noted in
both longitudinal and transverse views. It ap-
pears as two echogenic dots on transverse im-
ages and as a tubular structure with echogen-
ic walls on longitudinal images (Fig. 8). The
Fig. 7—26-year-old man
with traumatic epididymitis
due to sports injury.
A, Longitudinal gray-scale
image of epididymis shows
enlarged heterogeneous
epididymis (arrow). Hetero-
geneity is due to multiple,
small, avascular hemato-
mas. Calipers = testis.
B, Color Doppler image
shows increased vascular-
ity within epididymis (ar-
row), whereas contusions
have no vascularity.
 Scrotal and Penile Trauma

venous drainage of the corpora cavernosa is
through the small emissary veins, which drain
into the dorsal, cavernosal, and crural veins.
Penile Trauma
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location of the tear within the tunica albugin-
ea [35–38] (Fig. 9). In addition to ultrasound,
MRI can show excellent soft-tissue delinea-
tion in evaluation of the integrity of the tuni-
ca albuginea, which is hypointense on imag-
considered an emergency because it is not
associated with pain, and permanent erectile
dysfunction is unlikely.
Although the cause of priapism may be
known clinically, a cavernosa blood gas lev-

Penile Fracture
A penile fracture typically occurs in the
proximal or mid shaft of the erect penis.
Concomitant injury to the penile urethra oc-
curs in approximately 10–20% of cases and
should be suspected if blood is found within
the urethral meatus or if cavernosal injury is
bilateral [33, 34]. Patients with penile frac-
ture report hearing a cracking or popping
sound and feeling sharp pain followed by
rapid detumescence, swelling, discoloration,
and deformity of the penis, which is com-
monly described as eggplant deformity [3].
Penile fractures are urologic emergencies
and require immediate surgical exploration.
However, the diagnosis is usually delayed
because of the patient’s embarrassment.
The benefits of ultrasound are that it can
be used to evaluate normal anatomy and the
extent of injury and that it depicts the exact
es obtained with all pulse sequences whether
or not a hematoma is present [39].
Priapism
Priapism is defined as a prolonged penile
erection not associated with sexual desire.
Priapism is categorized as either low flow
(ischemic) or high flow (nonischemic). Mal-
function of normal penile flow due to hyper-
coagulability, sickle cell disease, or medi-
cation results in prolonged obstruction of
venous outflow leading to high cavernous
pressure, which causes irreversible isch-
emic changes and permanent erectile dys-
function. Therefore, priapism is considered
a true emergency [39].
High-flow priapism is caused by unregu-
lated arterial flow due to arterial trauma. Pa-
tients typically present with a painless erec-
tion after genitourinary trauma. This is not
el may be necessary to confirm the diagno-
sis with high oxygen tension. A less invasive
method is Doppler ultrasound to evaluate the
vascularity of the penis. Color and spectral
Doppler ultrasound depicts high blood flow
within the cavernosal artery (Fig. 10).
Intracavernosal Hematoma
Injury to the subtunical venous plexus or
smooth-muscle trabecula in the absence of
complete tunical disruption can lead to a
cavernosal hematoma [40]. Intracavernosal
hematomas are usually bilateral and result
from injury to the cavernosal tissue when the
base of the penis is crushed against the pel-
vic bones [38]. The sonographic appearance
of a penile hematoma can vary with its age.
In the acute phase, a hematoma is usually
hyperechoic and eventually becomes a cystic
lesion with septation [3]. Cavernosal damage

Fig. 8—53-year-old man with normal penis.

A, Drawing shows normal penile anatomy.
B and C, Transverse gray-scale (B) and longitudinal color Doppler (C) ultrasound
images of normal penis show corpora cavernosa (straight arrows, B), corpus spon-
giosum (large arrowhead, B), cavernosal arteries (small arrowheads), and tunica
albuginea (curved arrow, B).
A

B C

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 Nicola et al.
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A B
Fig. 9—40-year-old man with fractured penis.
A, Transverse gray-scale image of penis shows disruption of tunica (straight arrow) on left, right corpus caver-
nosum (arrowhead), and corpus spongiosum (curved arrow).
B, Longitudinal color Doppler image shows disruption of tunica (arrow) on left that results in organized hema-
toma (asterisk) under Buck fascia.
C, Intraoperative photograph shows disruption of tunica albuginea (arrow).

Fig. 10—56-year-old man in emergency department

with partial tumescence due to high-flow priapism.
A and B, Transverse (A) and longitudinal (B) color and
spectral Doppler images of penis show arteriovenous
fistula (arrow) between cavernosal artery and vein
secondary to trauma during sexual activity.
A B

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Fig. 12—34-year-old man with dorsal vein thrombosis after sexual activity.
A and B, Transverse (A) and longitudinal (B) gray-scale ultrasound images show thrombosed dorsal vein (arrow).
can cause fibrosis, which at ultrasound ap-
pears as an ill-defined echogenic scar replac-
ing the erectile tissue [41] (Fig. 11). If the tu-
nica albuginea is intact, the patient can be
treated conservatively.
Traumatic Avulsion of the Dorsal Penile Vessels
and Thrombosis
Rupture of the dorsal penile vessels can
be caused by sexual activity and mimics a
penile fracture [42]. However, deformity and
immediate detumescence of the penis do not
occur because the tunica albuginea is intact
[38]. This typically can be associated with a
hematoma. The hematoma can be either su-
perficial or remain under the Buck fascia, de-
pending on the site of involvement of the pe-
nile veins. If an arterial lesion is present, a
posttraumatic arteriovenous fistula with in-
creased venous pressures and dilation of
the injured vessels may result [38]. Throm-
bosis of the superficial and deep dorsal pe-
nile veins is a urologic emergency. However,
AJR:202, June 2014 W519
Scrotal and Penile Trauma
A B
the clinical and sonographic appearance can
mimic those of penile fracture. Ultrasound
shows a noncompressible dorsal vein; if rup-
ture has occurred, signs of hematoma also
are present [43] (Fig. 12).
Summary
Scrotal and penile trauma is an uncom-
mon type of trauma injury. It is important
for radiologists to become familiar with spe-
cific ultrasound findings to make a prompt
diagnosis so that the patient can be treated
appropriately. Ultrasound is typically the
modality of choice because of its accessibil-
ity, mobility, and noninvasiveness and be-
cause patient preparation is not necessary.
In addition, the use of color-flow, power, and
spectral Doppler techniques and high-reso-
lution imaging facilitates accurate assess-
ment of the integrity of the scrotum and pe-
nis, which is important in directing patient
care by either surgical exploration or conser-
vative treatment.
Fig. 11—40-year-old man with pain and swelling due
to cavernosal hematoma resulting from penile trauma
sustained during intercourse. Transverse gray-scale
ultrasound image shows echogenic hematoma (ar-
row) within left corpus.
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