Presentation
Priapism, post-shunting procedure. The base of the penis feels firm. Known sickle-cell anemia.
Patient Data
The B-mode and color Doppler ultrasound studies were done on a supine patient in a semi-detumescent state and did not reveal any plaques or calcifications in the tunica albuginea of the penis. No hematoma was present.
Edema of the tunica albuginea was noted on both corpora cavernosa. The Foley catheter was shown traversing the urethra within the corpus spongiosum.
The Cavernosal artery diameter was 0.7 mm for both the right and left sides. A peak systolic velocity of 43 cm/s on the right and 13.8 cm/s on the left side was seen. End diastolic velocity remained above 3.4 and 4.3 cm/s respectively. The dicrotic notching was more prominent on the right. The helical veins revealed flow reaching between 7 and 10 cm/s on both sides, which was phasic in nature.
No flow was seen in the deep dorsal vein, and it was incompressible due to a thrombus.
At the suprapubic and pubic areas, no mass or lesion was seen.
Case Discussion
Mild tumescence was visible 10 minutes after injection; however, the patient did not acquire full rigidity. Cavernosal arteries with elevated peak systolic velocity and low-end diastolic velocity with dicrotic notching are indicative of the likelihood of penile engorgement.
The thrombus in the deep dorsal vein is consistent with penile Mondor’s disease.
These findings increase the likelihood of ischemic (low flow) priapism.
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