| Minimum anatomic protocol | high-frequency linear transducer; transverse and longitudinal planes | Assess corpora cavernosa, corpus spongiosum, glans, penile urethra when relevant, tunica albuginea, deep fascia, cavernosal arteries, dorsal arteries, and superficial/deep dorsal veins according to the clinical question.Source: RadioGraphics 2024 / University of Washington penile ultrasound protocol / Radiologia Brasileira |
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| Normal B-mode anatomy | two dorsolateral corpora cavernosa + ventral corpus spongiosum | The tunica albuginea appears as a thin echogenic line around the erectile bodies; the cavernosal artery is usually seen in the center of each corpus cavernosum.Source: Translational Andrology and Urology / RadioGraphics |
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| Penile fracture | tunica albuginea discontinuity + hematoma | A snap, sudden pain, detumescence, and bruising make the clinical diagnosis likely; ultrasound localizes the tear and measures hematoma. Hematuria, urinary retention, or air in the erectile bodies suggest urethral injury and change urgency.continuous tunica: no deep hematomahematoma with intact tunica: fracture mimic differentiallikely fracture: tunical defectSource: Radiologia Brasileira 2019 / Translational Andrology and Urology 2017 |
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| Peyronie disease — plaque | focal tunical thickening, fibrosis, or calcification | Report location, side, length, thickness, calcification/acoustic shadowing, relationship to septum and neurovascular bundle, curvature during induced erection when performed, and Doppler flow around the plaque if active phase is suspected.noncalcified plaque: may be active phasecalcification: affects treatment planningmass or atypical erosion: do not assume PeyronieSource: AUA Peyronie guideline / RadioGraphics 2024 / Frontiers Pharmacol 2019 |
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| Ischemic priapism | markedly reduced or absent cavernosal flow | This is a urologic emergency, especially with a painful erection lasting more than 4 hours. Doppler should be performed before aspiration when possible, because intervention may create reactive hyperemia and confuse interpretation.emergency: pain + rigidity + little/no flowindeterminate: correlate with corporal blood gasSource: EAU Priapism guideline / AUA-SMSNA Priapism guideline / Radiologia Brasileira |
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| Nonischemic / high-flow priapism | high/turbulent flow, fistula, or pseudoaneurysm | Often follows perineal/penile trauma and is less painful. It is not the same emergency as ischemic priapism, but it is abnormal and Doppler localizes the fistula for guided compression, follow-up, or embolization.Source: EAU Priapism guideline / Radiologia Brasileira |
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| Superficial dorsal vein thrombosis | noncompressible vein + echogenic thrombus + absent flow | Also called penile Mondor disease. It is usually benign/self-limited, but Doppler helps distinguish it from Peyronie disease, sclerosing lymphangitis, mass, and hematoma.usually self-limited abnormality: confirm compressibility and flowsystemic signs or mass: look for another causeSource: Radiologia Brasileira / Korean J Radiol / case literature |
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| Dynamic Doppler — technique | measure cavernosal arteries at the base every 5 min up to 20-30 min | Record drug and dose, injection side, time, rigidity grade, peak systolic velocity, end-diastolic velocity, resistive index, and side-to-side difference. Doppler angle should be kept below 60 degrees.Source: EAU Erectile Dysfunction guideline / RadioGraphics 2024 / EPOS ECR 2024 |
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| Post-stimulation peak systolic velocity | strong green >35; divergent 30-35; abnormal <25 cm/s | European guidance considers above 30 cm/s usually normal; radiology reviews use above 35 cm/s to exclude significant stenosis. Between 25 and 35 cm/s, interpret as a gray zone with rigidity, dose, anxiety, and timing.strong normality: >35 cm/snormal in some sources: 30–35 cm/sindeterminate: 25–29 cm/slikely arterial insufficiency: <25 cm/sSource: EAU / Scientific Reports 2022 / RadioGraphics 2024 |
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| End-diastolic velocity | <3 by European guidance; >5 suggests venous leak if arterial inflow is adequate cm/s | Veno-occlusive interpretation is reliable only when arterial response and rigidity are sufficient; anxiety and low dose may mimic venous leak.strict normal: <3 cm/sgray zone: 3–5 cm/slikely venous leak: >5 cm/s com boa resposta arterialSource: EAU / RadioGraphics / EPOS ECR 2024 |
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| Resistive index | >0.8 usually normal | Below 0.8 together with elevated end-diastolic velocity suggests veno-occlusive dysfunction; use cautiously if arterial response was poor.normal: >0,8borderline: 0,75–0,80suspicious: <0,75 ou <0,8 com diástole elevadaSource: EAU / RadioGraphics / EPOS ECR 2024 |
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