Purpose or Case Report: A 13-year-old male presented to the emergency department with acute penile shaft swelling and pain after falling in the shower onto a partially erect penis. Initial ultrasound of the penis demonstrated a hypoechoic collection within the right ventrolateral midshaft, adjacent to an apparent focal discontinuity of the tunica albuginea. Additionally, a normal appearing urethra was identified. The patient was emergently brought to the operating room where a correlating tunica albuginea defect was not identified (via artificial erection with saline injection into the right corpora cavernosa), suggesting the absence of a penile fracture. Follow-up penile MRI revealed a urethral duplication, with injury to the ventral aspect of the dorsal urethra and an adjacent complex fluid collection. This represented a peri-urethral hematoma/urinoma. The ventral urethra was intact and unremarkable, accounting for the normal urethra visualized sonographically.

Urethral duplication is a rare congenital anomaly characterized by two urethras with variation in their location and courses. Type IIA 2 (Effman classification; seen in this patient) is the most complex form where there is proximal fusion of the two urethras prior to bladder insertion. Clinical manifestations vary but include penile deformation, urinary incontinence, and urinary tract infections. Traumatic urethral injury seen in patients with duplication is rare with no case reports found on literature review. Moreover, penile fracture mimics are not common as a clinical scenario and sonographic findings are relatively specific. The presented case demonstrates a rare scenario that may serve as a penile fracture mimic.
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