ª Springer Science+Business Media New York 2016

Abdominal Radiology

Abdom Radiol (2016) DOI: 10.1007/s00261-016-0853-1

The ‘‘eggplant penis’’ sign Pat W. Whitworth III,1 Parvati Ramchandani,2 Raymond B. Dyer1 1

Department of Radiology, Wake Forest Baptist Medical Center, Wake Forest University School of Medicine, Medical Center Blvd., Winston-Salem 27157, NC, USA 2 Department of Radiology, Perelman School of Medicine, Hospital of the University of Pennsylvania, 3400 Spruce St., Philadelphia 19104, PA, USA

The ‘‘eggplant penis’’ sign refers to the classic physical appearance of a discolored, fractured penis (Fig. 1) [1]. A fracture of the penis is a traumatic tear in the tunica albuginea surrounding the corpora cavernosa, due to

Fig. 2. An eggplant providing the namesake for the physical appearance.

Fig. 1. During sexual intercourse, this patient heard a ‘‘pop’’ and rapidly developed swelling and discoloration of his penis, prompting his presentation.

Correspondence to: Pat W. Whitworth III; email: [email protected] wakehealth.edu

abrupt bending of the erect penis. This injury usually occurs due to a ‘‘misdocking’’ event involving the erect penis [1, 2], but there are other causes, such as trauma during masturbation or kneading and snapping during attempts to achieve detumescence [2]. At the time of the tunical tear, there is often a ‘‘popping’’ sound with release of blood from the distended corpora cavernosa into the penile shaft. There is immediate loss of erection, with swelling, discoloration, and deviation of the penile shaft away from the side of the corporal injury [2]; these changes result in the characteristic ‘‘eggplant’’ appearance (Fig. 2) [1]. While the physical appearance and history described above are typical for penile fracture, penile ultrasound (Fig. 3) or MRI (Fig. 4) can be helpful in depicting the site of tunical injury and may be particularly useful in cases where the history or physical examination are equivocal. Recognition of the classic ‘‘eggplant’’ physical

P. W. Whitworth et al.: The ‘‘eggplant penis’’ sign

appearance by the imaging provider can guide targeted evaluation for tunical injury. Imaging is specifically indicated if there is suspected urethral injury, which occurs in 20% of penile fractures; such patients present with blood at the urethral meatus and retrograde urethrography is helpful in demonstrating the site and size of the urethral tear [2]. Expedient diagnosis and urgent surgical intervention are crucial for avoiding complications such as erectile dysfunction or disfigurement due to penile curvature [1, 2]. Compliance with ethical standards Funding No funding was utilized for this article. Conflict of Interest Pat Whitworth, Parvati Ramchandani, and Raymond Dyer declare that they have no conflict of interest.

Fig. 3. Ultrasound of a penile fracture in a different patient shows a defect in the tunica albuginea of the right corpora cavernosa (yellow arrows), with leakage of blood into the soft tissues of the penis (blue arrow).

Ethical approval This article does not contain any studies with human participants or animals performed by any of the authors.

References 1. Hartman RJ (2015) Images in clinical medicine: penile fracture. N Engl J Med 372:1055 2. Jack GS, Garraway I, Reznichek R, Rajfer J (2004) Current treatment options for penile fractures. Rev Urol 6:114–120

Fig. 4. MRI of a penile fracture in another patient showing a defect in the ventral aspect of the tunica albuginea (yellow arrows), with extravasation of blood into more superficial penile soft tissues (blue arrow). Image credit: Arumugam Rajesh, Postgraduate School of Radiology, East Midlands University Hospitals of Leicester NHS Trust.

The "eggplant penis" sign.

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