High Flow Priapism on ¹⁸FDG PET/CT in a Patient with Urothelial Carcinoma: Case Report

A Ouboukdir,Y Ghannam,J Benouhoud,C Waffar,H Lachhab

doi:10.24018/ejmed.2021.3.3.861

Abstract

We studied a 52-year-old man diagnosed with a high-grade urothelial carcinoma of the upper urinary tract treated with nephroureterectomy and chemotherapy who presented a benign high-flow priapism with intensive 18F-fluorodeoxyglucose (FDG) uptake as an unusual finding in the positron emission tomography (PET)/computed tomography (CT) that also showed mediastinal and lumbo-aortic node involvement and liver metastases. Upon examination, the patient had a painless erection that lasted for five days with no episode of recurrence at two-month follow-up.

Highlights

Priapism is defined as a prolonged and persistent penile erection lasting longer than four hours and unrelated to sexual activity, it is categorized as ischemic priapism and non-ischemic priapism [1]
We report on the case of a benign high-flow priapism discovered incidentally during the performance of a FDG positron emission tomography (PET)/computed tomography (CT) scan in a 52-year-old patient for assessment of the extension of his urinary tract carcinoma
Chemotherapy had been provided and the patient showed good clinical response. At two months he presented with chest pain and marked loss of weight, FDG PET/CT was performed and showed an unusual intense and diffuse FDG increased uptake of the penis (Fig. 1), an increased uptake of the tracer in mediastinal, lumbo-aortic lymph nodes and the liver (Fig. 2), and an hypermetabolism of the right spermatic vein satellite to his penile hypermetabolism, which supports the origin of a high flow priapism (Fig. 3)

Summary

INTRODUCTION

Priapism is defined as a prolonged and persistent penile erection lasting longer than four hours and unrelated to sexual activity, it is categorized as ischemic (low flow) priapism and non-ischemic (high flow) priapism [1]. We report on the case of a benign high-flow priapism discovered incidentally during the performance of a FDG PET/CT scan in a 52-year-old patient for assessment of the extension of his urinary tract carcinoma. Chemotherapy had been provided and the patient showed good clinical response. At two months he presented with chest pain and marked loss of weight, FDG PET/CT was performed and showed an unusual intense and diffuse FDG increased uptake of the penis (Fig. 1), an increased uptake of the tracer in mediastinal, lumbo-aortic lymph nodes and the liver (Fig. 2), and an hypermetabolism of the right spermatic vein satellite to his penile hypermetabolism, which supports the origin of a high flow priapism (Fig. 3)

CASE PRESENTATION

DISCUSSION