On history, this patient self-injected an intracavernosal agent (suspected to be alprostadil) to initiate tumescence.

He developed ischemic or low flow priapism for 3-5 hours.

Intracavernosal sympathomimetic injection (epinephrine) failed and the patient underwent a surgical procedure to facilitate drainage.

This was likely a surgical incision of the tunica albuginea at the penile base to facilitate drainage.

He presented three years later with permanent erectile dysfunction at which time the MRI scan was performed.

Features suggest chronic corpora cavernosal infarction with fibrosis and fatty infiltration.

The patient is now planning for a penile prosthesis.