The "Wet Collar" Sign: A Case of Paraphimosis on CT

Paraphimosis is a urologic emergency that requires prompt diagnosis to avoid potential morbidity. Diagnosis is made clinically and imaging findings have not been described. We will present the case of an 84-year-old man with a history of metastatic prostate cancer and prior pelvic external beam radiation therapy who presented to the emergency department with urinary retention. A urethral Foley catheter was placed for bladder decompression. He subsequently developed painful penile swelling and was found to have iatrogenic paraphimosis. Retrospective review of his contrast-enhanced CT of the abdomen and pelvis performed while in the emergency department before hospital admission revealed the relatively thickened, hypoattenuating prepuce located proximal to the corona of the glans penis, consistent with the clinical diagnosis. We will examine the imaging findings in this case and propose the novel "wet collar" sign to suggest the diagnosis of paraphimosis on CT.