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Imaging of Traumatic and Atraumatic
Penile Lumps
Sandy Van Nieuwenhove, MD
Julien Van Damme, MD
Axel Feyaerts, MD
Camilla Sachs, MD
Marin Halut, MD
Vassiliki Pasoglou, MD, PhD
Frédéric Lecouvet, MD, PhD
Etienne Danse, MD, PhD
Hélène Dano, MD
Michele Bertolotto, MD
RadioGraphics 2021; 41:E77–E78
https://doi.org/10.1148/rg.2021200197
Content Codes:
From the Departments of Radiology (S.V.N.,
M.H., V.P., F.L., E.D.), Urology (J.V.D., A.F.),
and Pathology (H.D.), Cliniques Universitaires
Saint-Luc, Université Catholique de Louvain,
Avenue Hippocrate 10, 1200 Brussels, Belgium;
S.C. Radiologia Pordenone Sacile, Azienda San-
itaria Friuli Occidentale (ASFO), Pordenone,
Italy (C.S.); and Department of Radiology, Uni-
versity of Trieste, Ospedale di Cattinara, Trieste,
Italy (M.B.). Recipient of a Cum Laude award
for an education exhibit at the 2019 RSNA An-
nual Meeting. Received September 23, 2020;
revision requested December 9 and received
January 6; accepted January 15. For this journal-
based SA-CME activity, the authors S.V.N. and
H.D. have provided disclosures (see end of ar-
ticle); all other authors, the editor, and the re-
viewers have disclosed no relevant relationships.
Address correspondence to S.V.N. (e-mail:
sandy.vannieuwenhove@uclouvain.be).
©
RSNA, 2021
E77
GENITOURINARY IMAGING |
The full digital presentation is available online.
Palpable nodules on the penile shaft, called penile lumps, are
encountered in benign conditions such as Peyronie disease and in
malignant lesions such as squamous cell carcinoma. Malignant le-
RADIOGRAPHICS FUNDAMENTALS
sions of the penis account for less than 1% of all malignant cancers
in the United States, and of these, approximately 95% are squa-
mous cell carcinomas. The diagnostic approach is primarily clinical
and depends on the patient’s medical history and the onset of the
symptoms. Imaging examinations, including principally US and
MRI, play a role in staging, preoperative planning, and assessing the
vasculature and viability of the penile tissues. Because of the relative
infrequency of penile diseases, performing and interpreting penile
imaging studies can be challenging for radiologists with less experi-
ence in urogenital imaging.
The penile shaft is composed of three cylindrical structures of
cavernous erectile tissue covered by the tunica albuginea: two dorsal
corpora cavernosa containing venous sinusoids. and the ventral
midline corpus spongiosum surrounding the urethra and forming
the glans. Close to the tunica albuginea, the Buck fascia holds the
corpora cavernosa and corpus spongiosum together and contains the
deep neurovascular bundles.
The imaging approach and physical examination are complemen-
tary, and the choice of the technique is guided by the underlying
cause of the penile induration. Causes can be categorized as trau-
matic, infectious, vascular, neoplastic, or nonneoplastic, depending
on the tenderness, temperature, consistency, and mobility of the
lesion.
Conventional US, color Doppler US, and spectral Doppler US,
although known as operator-dependent techniques, are the main
imaging modalities. Pharmacopenile duplex US performed after in-
tracavernosal injection of vasoactive drugs (prostaglandin E1) under
sterile conditions helps evaluate and guide the treatment of Peyronie
disease, which is the most frequently treated penile pathologic con-
dition. Penile blunt trauma is first imaged with US. This modality
can show a disruption of the tunica albuginea that should undergo
surgical repair. MRI is less accessible in an emergency setting but
can depict tears of the tunica albuginea with high sensitivity when
US is inconclusive. Retrograde urethrography remains the imaging
standard in patients with clinical suspicion for urethral leak.
TEACHING POINTS
„ Penile lumps are rare and are defined as focal palpable nodules along the penile shaft.
„ Causes of penile lumps can be categorized as traumatic, infectious, vascular, neoplastic,
or nonneoplastic, depending on the tenderness, temperature, consistency, and mobility
of the lesion.
„ The diagnostic approach is primarily clinical, with US as the primary imaging modality and
MRI as a second-line diagnostic tool.
E78 May-June 2021 radiographics.rsna.org

Figure. Carcinoma of the anterior urethra in a 65-year-old man with a painful ventral penile
lump and urethrorrhagia. (a, b) Sagittal (a) and coronal (b) T2-weighted MR images show
a hypointense ventral lesion arising from the corpus spongiosum (*) with retrodilatation of
the urethra (arrowheads in a). The infiltration of the corpus spongiosum (curved arrows in b)
and left corpus cavernosum (straight arrow in b) with the loss of hypointensity in the tunica
albuginea contraindicates penis-sparing surgery. (c) Axial diffusion-weighted image (b = 1500
sec/mm²) shows high signal intensity in the lesion (*). (d) Photograph of the corresponding
pathologic section shows the mass (*) infiltrating the corpus spongiosum (arrowheads) and
left corpus cavernosum (arrow).

In the case of inflammation, US plays a role in

excluding abscess or corpora cavernosa involve-
ment. In severe conditions such as gangrenous
cavernositis, CT or MRI are performed to help
assess the extent of the inflammation.
Vascular disorders such as partial corpus
cavernosal thrombosis, dorsal vein thrombosis,
and high- and low-flow priapism can be correctly
depicted with color and spectral Doppler US.
MRI plays an important role in demonstrating
viable tissue.
Malignant lesions such as primary penile or
urethral cancer, metastasis, rare diseases, and
postoperative complications (penile prosthesis
infection or silicone or fat granuloma) are better
evaluated at MRI owing to the higher soft-tissue
contrast and spatial resolution (Figure).
Clinical and imaging features are used to dif-
ferentiate malignant lesions from benign. These
lesions can be cystic (median raphe and epider-
moid cysts), mixed, or solid (primary penile or
urethral cancer and metastasis). Nevertheless,
biopsy is often mandatory in the case of nonspe-
cific US and MRI characteristics.
This online presentation provides a pictorial
review of common and uncommon penile lumps
in trauma, inflammation, vascular diseases, and
benign and malignant penile lesions. After view-
ing this online presentation, the reader should
be able to understand and interpret pathologic
conditions according to medical history, clinical
findings, and localization. To perform penile US
or MRI, the reader may require a more special-
ized type of training.
Disclosures of Conflicts of Interest.—S.V.N. Activities
related to the present article: disclosed no relevant rela-
tionships. Activities not related to the present article: stock
options provided by Cliniques Universitaires Saint-Luc
through BlueTrees. Other activities: disclosed no relevant
relationships. H.D. Activities related to the present article:
disclosed no relevant relationships. Activities not related
to the present article: stock options provided by Cliniques
Universitaires Saint-Luc through BlueTrees. Other ac-
tivities: disclosed no relevant relationships.
Suggested Readings
Avery LL, Scheinfeld MH. Imaging of penile and scrotal emer-
gencies. RadioGraphics 2013;33(3):721–740.
Bertolotto M, Pavlica P, Serafini G, Quaia E, Zappetti R. Pain-
ful penile induration: imaging findings and management.
RadioGraphics 2009;29(2):477–493.
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solid urethral and peri-urethral lesions. Insights Imaging
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Kirkham AP, Illing RO, Minhas S, Minhas S, Allen C. MR
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