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Case 89 

Case 89
Chapter:
Case 89
Source:
Genitourinary Radiology Cases
Author(s):

Mark E. Lockhart

and Rupan Sanyal

DOI:
10.1093/med/9780199975747.003.0089

History

  • 47-year-old male with firm penile nodule (Figures 89.1 and 89.2)

Diagnosis

Case 89 Peyronie’s Disease

Findings

  • Longitudinal and transverse ultrasound images (Figures 89.1 and 89.2) show linear shadowing calcified plaques involving the tunica albuginea (arrows in Figures 89.3 and 89.4).

Differential Diagnosis

  • The linear calcifications along the tunica albuginea noted here are suggestive of calcified plaques seen in Peyronie’s disease. Penile tumors present as irregular soft tissue masses on ultrasound. A penile foreign body can appear as a linear shadowing structure on ultrasound, but suggestive history is usually available.

Teaching Points

  • Peyronie’s disease is characterized by formation of fibrous tissue plaques within the tunica albuginea. Plaque formation causes penile deformity.

  • Etiology is unclear but may be due to microtrauma and subsequent aberrant scar formation.

  • Penile deformity, palpable plaques, and pain are presenting complaints.

  • Peyronie’s disease has an acute inflammatory stage followed by stabilization of symptoms.

  • Ultrasound is used to identify the extent and location of palpable and nonpalpable plaques.

  • Plaques are identified as areas of focal hyperechoic thickening of the tunica albuginea with associated shadowing. Plaque calcifications are associated with disease stabilization.

  • On MRI, plaques appear as T1 and T2 hypointense areas in the tunica.

Management

  • Conservative treatment in acute phase; surgery after disease stabilization for severe penile deformity

Further Reading

Kalokairinou K, Konstantinidis C, Domazou M, Kalogeropoulos T, Kosmidis P, Gekas A. US imaging in Peyronie’s disease. J Clin Imaging Sci. 2012;2:63.Find this resource:

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