Ruptured Median Raphe Cyst Mimicking a Vascular Penile Mass on Ultrasound.

Amir Pakray,Andrew Surro,Ahmad Tahawi,Donald Gibson,Daniel P Link

doi:10.1155/2022/8899541

Amir Pakray, Andrew Surro + Show 3 more

Open Access

https://doi.org/10.1155/2022/8899541

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Abstract

Median raphe cysts are uncommon benign cysts thought to occur due to improper fusion of the genital tubercle and can occur anywhere along the median raphe, from the glans to the anus, most commonly occurring along the ventral penile shaft. Limited information is available in the literature about the common imaging features of median raphe cysts with available reports highlighting an avascular cystic lesion. Our case demonstrates a 10-year-old male patient presenting with a ventral penile mass that demonstrated interval growth in the absence of trauma without overlying skin changes. Doppler ultrasound examination demonstrated a solid vascular mass measuring up to 1.6 cm at the ventral aspect of the penis with arterial and venous waveforms. The patient underwent elective resection of the mass which revealed a 2.0 cm inflamed glandular subtype median raphe cyst. This report demonstrates an atypical imaging presentation of an inflamed median raphe cyst, particularly that of a heterogeneous solid mass with arterial and venous blood flow on ultrasound.

Highlights

Median raphe cysts (MRC) are rare benign cysts known to occur along the median raphe, which extends from the urethral meatus and continues caudally along the scrotum down to the perineum
Typical imaging features of MRCs in the literature are those of an avascular cystic lesion on ultrasound [3–6]
The most atypical feature was internal Doppler flow with arterial and venous waveforms on spectral analysis, which is most consistent with a vascular mass

Summary

Introduction

Median raphe cysts (MRC) are rare benign cysts known to occur along the median raphe, which extends from the urethral meatus and continues caudally along the scrotum down to the perineum. They are thought to arise due to abnormal fusion of the genital tubercle during the fourth week of fetal development; various theories exist in the literature with the exact pathogenesis uncertain [1]. Ultrasound and MRI allow for anatomical assessment in order to understand the extent of the lesion and to rule out communication with neighboring structures or vascularity. Delayed intervention can result in inflammation of the MRC increasing the likelihood of iatrogenic urethral injury in addition to the cosmetic and symptomatic manifestations of treatment delay [5]

Case Presentation

Discussion

Conclusion