High Flow Priapism on Color Doppler Ultrasound

Abstract

A 25-year-old male patient presented with a 3-day history of persistent, painless semirigid erection. He had no history of recent trauma, hematological disease or drug use (recreational, psychotropic or oral supplement). On examination the penile shaft was turgid and nontender. Diffuse ecchymosis was noted along the shaft and scrotum. Arterial blood gas analysis from cavernous aspirate showed pH 7.45, pCO2 36.9, pO2 71.8 and HCO 3 24.3. Complete blood count and urinalysis were normal. The clinical findings were consistent with arterial, nonischemic (high flow) priapism.Color Doppler ultrasound (CDU), requested to identify the presence of a potentially treatable arterio-lacunar (AL) fistula, showed asymmetric increased arterial flow in the left cavernosal artery. The right cavernosal artery was patent with a peak systolic velocity of 19 cm per second and the left cavernosal artery had elevated peak systolic velocity greater than 120 cm per second. The left cavernosal arterial spectral Doppler also showed spectral broadening and color Doppler revealed a blush in the left mid shaft consistent with an AL fistula (see figure). There was no flow in the left cavernosal artery immediately beyond this blush but collateral flow was present distally.Priapism is a persistent penile erection lasting more than 4 hours unrelated to a sexual stimulus.

Combination High Flow Priapism With Low Flow Priapism: Case Report

“…5.8% were described in patients with inherited diseases, and the etiology was not clear in 16.7%. The most common fistula location was cavernosal (72%) 7, 8. Color Doppler ultrasonography, the preferred diagnostic tool, has a sensitivity of nearly 100% 9 .…”