CASE REPORT MRI in the diagnosis of diphallia Mahyar Ghafoori & Peyman Varedi & Seyed Jalil Hosseini Received: 1 May 2007 / Revised: 30 July 2007 / Accepted: 31 July 2007 / Published online: 2 October 2007 # Springer-Verlag 2007 Abstract Diphallia or duplication of the penis is an ex- tremely rare but well-documented anomaly. According to the presence of one or two corpora cavernosa in each of the penises, diphallia is classified into two major groups of bifid phallus or true diphallia, respectively. We report a 5-year-old boy with duplication of the penis. Significant separation of the penises and their morphology made them appear as true complete phalluses, but MRI established the definitive diagnosis of bifid phallus by demonstrating the presence of one corpus cavernosum in each penis. MRI is a valuable method for achieving the accurate diagnosis of these anom- alies and associated malformations. It also provides the ap- propriate knowledge regarding anatomical detail and assists the surgeon in decision making and preoperative planning for the optimal surgical approach. Keywords Penis . Duplication . Diphallia . MRI . Child Introduction Diphallia, or duplication of the penis, is an extremely rare congenital malformation [1, 2]. The extent of duplication and accompanying anomalies vary greatly [3–6]. MRI has recently been advocated for the precise noninvasive diag- nosis of these anomalies [7]. Here we present a case of bifid phallus that was successfully diagnosed using MRI and discuss the value of MRI in the diagnosis of the various forms of diphallia and associated anomalies. Case report A 5-year-old boy was referred to our department for pre- operative evaluation of abnormal external genitalia. He was the product of a full-term uneventful gestation. His parents described a life-long history of voiding through two urethral meati. He had received treatment for urinary tract infection several times during his life. On physical examination, he was found to have normal growth and psychomotor de- velopment. Examination of the external genital showed two separate phalluses. One was located ventrally and the other dorsally in the sagittal plane. The dorsal penis was normal in length and shape whereas the ventral one was smaller (Fig. 1). The scrotal sac and perineal region was normal. The remainder of physical examination was unremarkable. T1-weighted (T1-W; TR/TE 500/27 ms) and T2-weighted (T2-W; TR/TE 3,000, 2,420/86 ms) MR images were ob- tained in the axial, coronal and sagittal planes using a 1.5-T machine (Intera, Philips, Best, The Netherlands). T2-W images had better contrast resolution and differentiated the anatomical structures more satisfactorily. On the images obtained the posterior urethra started normally from the bladder base and passed through the prostate and then through the urogenital diaphragm to form the bulbous urethra (Fig. 2). The membranous urethra with its normal target shape was demonstrated on the axial T2-W images immediately Pediatr Radiol (2007) 37:1298–1300 DOI 10.1007/s00247-007-0627-6 M. Ghafoori (*) : P. Varedi Radiology Department, Hazrat Rasoul Akram Hospital, Niyayesh Street, Shahrara, Tehran, Iran e-mail: mahyarghafoori@hotmail.com S. J. Hosseini Department of Urology, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran