Case Provided By: Nicole Del Valle, PGY-3
Congrats to Michael Levine, PGY-1 and Han Xu, PGY-2 on getting to the correct diagnosis of an inflatable penile prosthesis!
On initial examination, we were worried about bladder rupture and a “positive FAST” exam but on reassessment, the patient still had stable vitals, no abdominal tenderness, and no signs of external trauma. With additional views (as seen in the gifs on the initial post), we noticed the fluid filled structure appeared to be separate from the bladder and had what appeared to be a balloon inside the collection (similar in appearance to what a foley balloon looks like). The patient then admitted to having a penile prosthesis.
Inflatable penile implants account for more than 90% of all penile prosthesis. This type of prosthesis consists of 3 parts: (1) a small pump implanted in the scrotum that, when squeezed, causes fluid to flow from a (2) reservoir in the pelvis to (3) two cylinders in the penis.
It is important for ED physicians to recognize the cystic structure of the
prosthesis reservoir on ultrasound and its relationship to the bladder. Failure to do so can lead to a misdiagnosis (i.e. free fluid in pelvis in the setting of trauma) and unnecessary procedures or further imaging on the patient.
Shout out to Nicole Del Valle and getting her case published in AAEM’s Pocus Report:
DelValle, N.; Singh, M. “Ultrasound Saves: Pump Up Your POCUS Skills.” The POCUS Report: Newsletter of the Emergency Ultrasound Section of AAEM (EUS-AAEM), American Academy of Emergency Medicine, Vol 3, Issue 1, June 2020, https://www.aaem.org/get-involved/sections/eus/newsletter/summer-2020#us_saves.