Differential Diagnosis for 42 yo Male with Severe Pain with Sex, Ecchymotic Penis, and Dark Blood from the Penis
- Single Most Likely Diagnosis
- Penile fracture: This condition is characterized by a traumatic rupture of the tunica albuginea, often occurring during vigorous sexual activity. The presentation of severe pain, ecchymosis, and a bulge (indicative of a hematoma) followed by dark blood from the penis is highly suggestive of this diagnosis.
- Other Likely Diagnoses
- Peyronie's disease: This condition involves the formation of fibrous scar tissue within the penis, leading to painful erections and potentially curvature of the penis. While it might not directly cause dark blood, the pain and potential for trauma during sex could be related.
- Penile thrombosis or embolism: Although less common, a thrombotic or embolic event in the penile vasculature could lead to severe pain and potentially bleeding, especially if there's infarction of penile tissue.
- Do Not Miss Diagnoses
- Penile cancer: Although rare and less likely given the acute presentation, any unexplained bleeding from the penis warrants consideration of malignancy to avoid delayed diagnosis.
- Trauma with arterial injury: Direct trauma to the penis could result in arterial injury, leading to significant bleeding. This would be a medical emergency requiring immediate intervention.
- Rare Diagnoses
- Fabry disease: A genetic disorder that can lead to vascular dysfunction, including potential for thrombotic events or bleeding due to endothelial dysfunction. It's a rare condition but could potentially explain some of the symptoms in the context of systemic disease.
- Sickle cell disease with priapism: In patients with sickle cell disease, priapism (a prolonged erection) can occur and may lead to pain and potentially bleeding if the priapism results in tissue ischemia and infarction.