Point-of-care ultrasound used to exclude penile fracture

Penile fracture is a well recognized yet relatively infrequent occurrence, accounting for approximately 1 in 175,000 hospital admissions [1]. The classic presentation includes post-traumatic penile pain associated with shaft deviation, eccyhmosis, and a palpable defect in the tunica albuginea usually due to trauma during sexual intercourse or masturbation [2]. Occasionally, the presentation is more subtle, and diagnosis based on history and physical examination alone is not possible. We present a case in which point-of-care ultrasound was used to exclude a penile fracture in a patient with some, but not all, of the characteristic clinical findings.A 29-year-old uncircumsized male presented to our emergency department approximately 30 min after being struck in the groin with the butt of a rifle. He stated that his penis was flaccid at the time of the injury and complained of pain and swelling to his penile shaft. Physical exam revealed significant edema of the penis and foreskin as well as the so-called ‘eggplant deformity’ commonly associated with penile fractures (Figure 1a). There was no palpable defect or pain to palpation over the corpus cavernosa and no testicular swelling or tenderness to palpation. Point-of-care ultrasound was performed and showed a distal foreskin hematoma surrounding the glans (Figure 1b). The cavernosa and the tunica albuginea appeared to be intact (Figure 1c). The patient was admitted to the urology service for observation overnight and discharged the following day. In follow-up, the patient’s edema resolved, and he had been able to sustain nonpainful erections without difficulty.The penile body is composed of three erectile structures, two corpus cavernosa (right and left) and one corpus spongiosa (central), which contains the penile urethra. The tunica albuginea is a fibrous sheath that encapsulates all three structures. A penile fracture occurs when the tunica albuginea and corpus carvernosa are ruptured, almost always secondary to tra