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Musculoskeletal/Small parts » Penis
Peyronie's disease
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Author(s) :
S. Manohar, MD, DMRD
 
Presentation A 40 year old man presents with painful erections and is referred for a penile ultrasound.
 
 
 
Caption: Transverse scan of the penis
Description: This image shows curvilinear, fibrous echogenic plaques without shadowing on the surface of both corpora cavernosa.
 
 
 
Caption: Right para-sagittal scan of the penis
Description: This image well demonstrates the fibrous plaques with calcification anterior to the corpus.
 
 
 
Caption: Left para-sagittal section of the penis
Description: This image also demonstrates the calcified fibrous plaques anterior to the corpus.
 
 
 
Caption: Transverse scan of the penis in the mid-shaft
Description: This image demonstrates the anteriorly placed fibrous plaques as marked by the arrows. Also noted is an intra-cavernosal plaque also marked by an arrow, which displays minimal posterior shadowing.
 
 
 
Caption: Transperineal scan
Description: The transperineal view demonstrates well the prostatic urethra which is normal.
 
 
 
Caption: Para-sagittal section of the penis
Description: This image also demonstrates the extensively calcified plaques.
 
 
 
Caption: Para-sagittal section of the penis
Description: This is a scan at a slightly different plane demonstrating the calcified linear plaques again.
 
 
 
Caption: Soft tissue radiograph
Description: This radiograph demonstrates the linear penile calcification.
 
Discussion Peyronie’s disease is an acquired disease of unknown etiology, affecting middle aged men with formation of fibrous plaques in the penile erectile tissue, resulting in scar tissue. Microvascular trauma to the penis with resultant localized fibrin deposition for wound healing is one of the factors that have been implicated in the development of these plaques. The plaques may eventually harden and cause deviation of the penis, indentation and shortening of the penis and may result in painful erections or difficulty in sexual intercourse.

Clinical examination, soft-tissue radiographs and ultrasound are all diagnostic modes that can be used to arrive at a definitive diagnosis. Ultrasound shows focal echogenic plaques anterior to or within the corpora cavernosa of the penis. Some of these plaques may calcify. The ultrasound appearance is classic and cannot be mistaken for any other pathology.

This case is demonstrated here to highlight the importance of high resolution penile ultrasound in establishing the diagnosis of Peyronie`s disease by identifying the echogenic plaques in the erectile tissue of the penis.
 
Case References 1. Fornara P, Gerbershagen HP. Ultrasound in patients affected with Peyronie`s disease. World J Urol. 2004 Nov; 22(5):365-7. Epub 2004 Jul 28.
2. Z Amin, U Patel, EP Friedman, et al. Colour Doppler and duplex ultrasound assessment of Peyronie`s disease in impotent men. The British Journal of Radiology 1993. Vol 66, Issue 785 398-402.
3. Jalkut M, Gonzalez-Cadavid N, Rajfer J. New discoveries in the basic science understanding of Peyronie`s disease. Curr Urol Rep. 2004 Dec; 5(6):478-84.  
 
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