Single most likely diagnosis
- Penile fracture: This is the most likely diagnosis due to the nature of the injury, which typically occurs when the erect penis is forcibly bent or hit, causing a rupture of the tunica albuginea, the fibrous layer surrounding the corpora cavernosa.
Other Likely diagnoses
- Penile hematoma: This could be considered if the injury results in significant bleeding into the soft tissues of the penis without a fracture.
- Urethral injury: If the mechanism of injury involves a direct blow to the penis or perineum, there could be an associated urethral injury.
Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Testicular torsion: Although less directly related to a "broken penis," testicular torsion is a urological emergency that can occur with trauma to the genital area and requires immediate attention.
- Vascular injury: Significant vascular injury could lead to ischemia or severe bleeding, both of which are emergencies.
Rare diagnoses
- Peyronie's disease: This condition involves the development of scar tissue inside the penis, leading to curved, painful erections. While it's not typically associated with acute trauma, it could be considered in the differential for chronic conditions affecting penile integrity.
- Penile cancer: Extremely rare and unlikely to be directly related to an acute injury, but any unexplained penile mass or lesion should prompt consideration of malignancy.