A 23-year-old man was admitted at 02:00 hours with a history of sudden severe penile pain, detumescence and bruising during sexual intercourse less than an hour previously. There was no associated snapping sound nor gross deformity. There was no evidence of urethral injury. A clinical diagnosis of ruptured corpus cavernosum was made. The patient was managed conservatively with analgesics and prophylactic antibiotics and was discharged home within 24 hours.

An MRI scan was performed 7 days after the injury to exclude any deficiency of the tunica albuginea. This revealed a localised area of high signal on T1- and T2-weighting at the bulb of the corpus spongiosum suggestive of a haematoma distant and isolated from the site of the injury (Figures 1 and 2 respectively). A follow-up MRI scan 3 months later showed persistant high signals in the corpus spongiosum mass.

Ultrasound with doppler scan of the perineum showed a well defined mass with no significant internal structure or blood flow, thus excluding incidental vascular malformation. Except for mild penile curvature during erection reported after 2 months, the patient was asymptomatic 16 months after injury.

This unexpected finding is to our knowledge the first report of an isolated, localised corpus spongiosum haematoma distant from the site of a penile fracture. However, the pathogenesis is easily conceivable. Since the 3 coporeal bodies (2 corpora cavernosa and the corpus spongiosum) are enclosed within Buck's fascia, and the pressure in the corpora cavernosa exceeds that in the corpus spongiosum during erection, a rupture of the cavernosum with the Buck's fascia intact will be expected to force the blood into the lower pressure area of the spongiosum.

MRI provides useful imaging of penile injuries1. After several days or weeks of its occurence, the MRI signal intensity of a haematoma becomes very strong on both T1- and T2-weighted images2 as in this case. This situation may persist for several months and is reliable for indentifying the presence of blood2.

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