1. Not It! Jenelle Beadle 2/1/2016

2. Segmental Anatomy

3. Orientation Prox Dist

4. Orientation Dorsal Ventral

5. Cavernosa = Dorsal Spongiosum = Ventral

7. Psst! It’s pronounced alb-you-jin-ee-uh

8. Fascial Layers

9. Tunica Albuginea Thickness Flacid: 1-2 mm Erect: 0.25-0.5mm

10. Tunica Albuginea Thickness Flacid: 1-2 mm Erect: 0.25-0.5mm

11. Tunica Albuginea Thickness Flacid: 1-2 mm Erect: 0.25-0.5mm

12. MRI better visualization of anatomy Ultrasound cheaper evaluate blood flow with Doppler

13. TraumaPainErection Fracture Low Flow Priapism High Flow Priapism

14. LOW FLOW PRIAPISM (ISCHEMIC) HIGH FLOW PRIAPISM (NON-ISCHEMIC)  outflow obstruction  idiopathic  drug related  more common  sustained rigid erection (glans spared)  painful  emergency  stagnation leads to ischemic corpora  often presents within hours  increased inflow  AV fistula (trauma)  no outflow obstruction  less common  sustained partial erection  painless  non-emergent  well oxygenated corpora  may take days to weeks to present

15.  Tear in the tunica albuginea  disrupted tunica with associated hematoma  hx of trauma  immediate detumescence  painful  swelling  discoloration

16. Long Trans

17. Long Trans C C S

18. LongTrans

19. LongTrans C C S

22.  palpable abnormality  focal tenderness  abnormal curvature

23.  palpable abnormality  focal tenderness  abnormal curvature Most common finding: Peyronie’s Disease

24.  Cause is not completely understood  trauma, meds, diabetes  Scarring of the tunica albuginea  dorsal (most common), ventral and septal  originates immediately deep to the tunica albuginea

25.  Ultrasound Findings  Focal thickening  typically linear and calcified with shadowing  echogenic, isoechoic, hypoechoic

28. Scarring is not elastic Results in curvature during erection towards the defect

29.  Thrombophlebitis of the superficial dorsal vein  cord-like palpable abnormality  painful  Self limiting  treated like any other superficial thrombophlebitis  warm compress  Anticoagulants  Same name when it occurs in the chest wall

30.  No written protocol  Scheduled as an extremity with rad time  ER and outpatient  we do not schedule these for erectile dysfunction  Any sonographer expected to scan  Any body radiologist expected to read  radiologist must be given the opportunity to scan  Most important structure to evaluate is the tunica albuginea  must be examined from multiple approaches

31. Dorsal Parasagittal Ventral Parasagittal & Midline Coronal Rt & Lt Lateral Ultrasound examination requires multiple approaches:

32. Dorsal Parasagittal Ventral Parasagittal & Midline Coronal Rt & Lt Lateral

33. Ultrasound examination requires multiple approaches: Dorsal Parasagittal Ventral Parasagittal & Midline Coronal Rt & Lt Lateral

34.  Dorsal (3 images, 1 cine)  Long Rt & Lt Cavernosum  Trans Cavernosa  Trans Dorsal Cine Prox-Dist  Coronal – Rt & Lt (2 images)  Long Lateral Rt Cavernosum  Long Lateral Lt Cavernosum  Ventral (2 images, 1 cine)  Long Spongiosum  Trans Spongiosum  Trans Ventral Cine Prox-Dist  Area of concern  Additional images as necessary to evaluate pathology  be as specific as possible when describing location