Abstract
The ideal imaging modality should demonstrate the presence or absence of a clinically significant, causative vascular lesion that, in high-flow arterial priapism, may need intervention. We report a 22-year-old male with post-traumatic arterial priapism. Color Doppler ultrasound could not reliably identify a significant vascular lesion. Magnetic resonance angiography (MRA) demonstrated the presence of a cavernous artery pseudoaneurysm. Based on this finding, embolization was decided, with a successful outcome. Contrast-enhanced MRA appears to be a useful, noninvasive diagnostic tool for decision making in cases of high-flow priapism.
Highlights
Priapism is a persistent penile erection that continues more than 4 h, unrelated to sexual stimulation
Perineal or penile trauma is the most common cause of high-flow priapism (HFP), and this is usually due to an AV fistula or a pseudoaneurysm of the cavernosal vessels
Most cases (85%) of priapism appear to be of veno-occlusive origin, and this is termed low flow, ischemic, or painful priapism
Summary
Priapism is a persistent penile erection that continues more than 4 h, unrelated to sexual stimulation. It is divided into ischemic (veno-occlusive, low flow) painful priapism and nonischemic (arterial, high flow) painless priapism[1]. Perineal or penile trauma is the most common cause of high-flow priapism (HFP), and this is usually due to an AV fistula or a pseudoaneurysm of the cavernosal vessels. The choice of the optimal line of management depends on the presence or absence of a clinically significant, causative lesion that may need intervention. We describe the use of noninvasive imaging to facilitate the choice of an ideal approach for such a clinical dilemma
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