HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Abstract Full Text Full Text (PDF) Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Bertolotto, M. Articles by Gattuccio, I. Search for Related Content PubMed PubMed Citation Articles by Bertolotto, M. Articles by Gattuccio, I. Related Collections Ultrasound Vascular and/or Interventional Radiology Genitourinary Radiology

Color Doppler Imaging of Posttraumatic Priapism before and after Selective Embolization¹

¹ From the Departments of Radiology (M.B., E.Q., F.P.M., B.F.) and Urology (S.C., I.G.), University of Trieste, Ospedale di Cattinara, Strada di Fiume 447, 34149 Trieste, Italy. Recipient of a Certificate of Merit award for an education exhibit at the 2001 RSNA scientific assembly. Received April 9, 2002; revision requested May 22 and received July 8; accepted July 9. Address correspondence to M.B. (e-mail: bertolot@univ.trieste.it).

View larger version (164K): [in a new window]   Figure 1a.  Recent versus long-standing high-flow priapism. Sagittal US of the penis was performed with the probe on the ventral aspect in the area surrounding the arterial-lacunar fistula. (a) Gray-scale scan of a patient who was studied 7 days after the trauma shows an irregular hypoechoic region (*) within the echogenic cavernous tissue due to distention of the lacunar spaces and tissue injury. (b) Gray-scale scan of a patient who presented 29 years after the trauma shows a cavernosal lacuna (arrowheads) with well-circumscribed margins, which mimics a pseudoaneurysm.

View larger version (153K): [in a new window]   Figure 1b.  Recent versus long-standing high-flow priapism. Sagittal US of the penis was performed with the probe on the ventral aspect in the area surrounding the arterial-lacunar fistula. (a) Gray-scale scan of a patient who was studied 7 days after the trauma shows an irregular hypoechoic region (*) within the echogenic cavernous tissue due to distention of the lacunar spaces and tissue injury. (b) Gray-scale scan of a patient who presented 29 years after the trauma shows a cavernosal lacuna (arrowheads) with well-circumscribed margins, which mimics a pseudoaneurysm.

View larger version (61K): [in a new window]   Figure 2a.  Color Doppler US findings in high-flow priapism. (a) Duplex US image shows that the cavernosal artery feeding the fistula has high-velocity flow. (b) Sagittal color Doppler image shows color blush (arrowheads) in the area of the cavernosal tear. (c) Axial color Doppler image obtained with the color velocity scale tuned to display high-velocity flow shows reduced size of the color blush (arrowheads). The exact site of the tear is clearly visible as a small color spot (light blue). (d) Duplex US image of the fistula shows high-velocity, turbulent flow.

View larger version (170K): [in a new window]   Figure 2b.  Color Doppler US findings in high-flow priapism. (a) Duplex US image shows that the cavernosal artery feeding the fistula has high-velocity flow. (b) Sagittal color Doppler image shows color blush (arrowheads) in the area of the cavernosal tear. (c) Axial color Doppler image obtained with the color velocity scale tuned to display high-velocity flow shows reduced size of the color blush (arrowheads). The exact site of the tear is clearly visible as a small color spot (light blue). (d) Duplex US image of the fistula shows high-velocity, turbulent flow.

View larger version (98K): [in a new window]   Figure 2c.  Color Doppler US findings in high-flow priapism. (a) Duplex US image shows that the cavernosal artery feeding the fistula has high-velocity flow. (b) Sagittal color Doppler image shows color blush (arrowheads) in the area of the cavernosal tear. (c) Axial color Doppler image obtained with the color velocity scale tuned to display high-velocity flow shows reduced size of the color blush (arrowheads). The exact site of the tear is clearly visible as a small color spot (light blue). (d) Duplex US image of the fistula shows high-velocity, turbulent flow.

View larger version (106K): [in a new window]   Figure 2d.  Color Doppler US findings in high-flow priapism. (a) Duplex US image shows that the cavernosal artery feeding the fistula has high-velocity flow. (b) Sagittal color Doppler image shows color blush (arrowheads) in the area of the cavernosal tear. (c) Axial color Doppler image obtained with the color velocity scale tuned to display high-velocity flow shows reduced size of the color blush (arrowheads). The exact site of the tear is clearly visible as a small color spot (light blue). (d) Duplex US image of the fistula shows high-velocity, turbulent flow.

View larger version (180K): [in a new window]   Figure 3a.  Priapism circumscribed to the base of the penile shaft. (a) Axial US scan shows bilateral cavernous hematomas (*) at the base of the penis. (b) Duplex US image of the right cavernosal artery shows an arterial-lacunar fistula. (c) Axial US scan obtained 6 months later shows that the echotexture of the corpora cavernosa is inhomogeneous due to fibrous changes in the cavernosal tissue in the areas of the previously detected cavernous hematomas (*). The patient reported normal erections.

View larger version (105K): [in a new window]   Figure 3b.  Priapism circumscribed to the base of the penile shaft. (a) Axial US scan shows bilateral cavernous hematomas (*) at the base of the penis. (b) Duplex US image of the right cavernosal artery shows an arterial-lacunar fistula. (c) Axial US scan obtained 6 months later shows that the echotexture of the corpora cavernosa is inhomogeneous due to fibrous changes in the cavernosal tissue in the areas of the previously detected cavernous hematomas (*). The patient reported normal erections.

View larger version (174K): [in a new window]   Figure 3c.  Priapism circumscribed to the base of the penile shaft. (a) Axial US scan shows bilateral cavernous hematomas (*) at the base of the penis. (b) Duplex US image of the right cavernosal artery shows an arterial-lacunar fistula. (c) Axial US scan obtained 6 months later shows that the echotexture of the corpora cavernosa is inhomogeneous due to fibrous changes in the cavernosal tissue in the areas of the previously detected cavernous hematomas (*). The patient reported normal erections.

View larger version (201K): [in a new window]   Figure 4a.  High-flow priapism. (a) Axial color Doppler image shows a fistula (arrowhead) in the left corpus cavernosum. (b) Angiogram shows that the fistula (arrowhead) is fed by a right accessory pudendal artery. (c) Axial color Doppler image obtained after embolization of the vessel shows occlusion of the fistula (*).

View larger version (192K): [in a new window]   Figure 4b.  High-flow priapism. (a) Axial color Doppler image shows a fistula (arrowhead) in the left corpus cavernosum. (b) Angiogram shows that the fistula (arrowhead) is fed by a right accessory pudendal artery. (c) Axial color Doppler image obtained after embolization of the vessel shows occlusion of the fistula (*).

View larger version (198K): [in a new window]   Figure 4c.  High-flow priapism. (a) Axial color Doppler image shows a fistula (arrowhead) in the left corpus cavernosum. (b) Angiogram shows that the fistula (arrowhead) is fed by a right accessory pudendal artery. (c) Axial color Doppler image obtained after embolization of the vessel shows occlusion of the fistula (*).

View larger version (195K): [in a new window]   Figure 5a.  High-flow priapism. (a) Sagittal color Doppler image of the left crus shows extravasation of blood (arrowheads) from the left cavernosal artery (arrow). (b) Angiogram shows extravasation of contrast material (arrowhead) from the torn vessel, an appearance indicative of arterial laceration. (c) Angiogram obtained after embolization shows occlusion of the fistula. At clinical evaluation, the penile turgescence was reduced. (d) Duplex US image obtained soon after angiography shows that the fistula is still patent but reduced in size. The fistula closed spontaneously within 1 week.

View larger version (185K): [in a new window]   Figure 5b.  High-flow priapism. (a) Sagittal color Doppler image of the left crus shows extravasation of blood (arrowheads) from the left cavernosal artery (arrow). (b) Angiogram shows extravasation of contrast material (arrowhead) from the torn vessel, an appearance indicative of arterial laceration. (c) Angiogram obtained after embolization shows occlusion of the fistula. At clinical evaluation, the penile turgescence was reduced. (d) Duplex US image obtained soon after angiography shows that the fistula is still patent but reduced in size. The fistula closed spontaneously within 1 week.

View larger version (207K): [in a new window]   Figure 5c.  High-flow priapism. (a) Sagittal color Doppler image of the left crus shows extravasation of blood (arrowheads) from the left cavernosal artery (arrow). (b) Angiogram shows extravasation of contrast material (arrowhead) from the torn vessel, an appearance indicative of arterial laceration. (c) Angiogram obtained after embolization shows occlusion of the fistula. At clinical evaluation, the penile turgescence was reduced. (d) Duplex US image obtained soon after angiography shows that the fistula is still patent but reduced in size. The fistula closed spontaneously within 1 week.

View larger version (169K): [in a new window]   Figure 5d.  High-flow priapism. (a) Sagittal color Doppler image of the left crus shows extravasation of blood (arrowheads) from the left cavernosal artery (arrow). (b) Angiogram shows extravasation of contrast material (arrowhead) from the torn vessel, an appearance indicative of arterial laceration. (c) Angiogram obtained after embolization shows occlusion of the fistula. At clinical evaluation, the penile turgescence was reduced. (d) Duplex US image obtained soon after angiography shows that the fistula is still patent but reduced in size. The fistula closed spontaneously within 1 week.

View larger version (182K): [in a new window]   Figure 6a.  High-flow priapism. (a) Sagittal color Doppler image shows an arterial-lacunar fistula in the right corpus cavernosum. (b) Angiogram shows the fistula (arrowhead), which is fed by the right cavernosal artery. After embolization, the penis remained tumescent. (c) Duplex US image shows high-velocity, turbulent flow, which indicates that the fistula is still patent. The low-velocity diastolic flow suggests an intracavernosal pressure similar to the diastolic arterial pressure. (d) Repeat angiogram shows that the fistula (arrowhead) is fed by contralateral vessels. The right cavernosal artery has been obliterated.

View larger version (208K): [in a new window]   Figure 6b.  High-flow priapism. (a) Sagittal color Doppler image shows an arterial-lacunar fistula in the right corpus cavernosum. (b) Angiogram shows the fistula (arrowhead), which is fed by the right cavernosal artery. After embolization, the penis remained tumescent. (c) Duplex US image shows high-velocity, turbulent flow, which indicates that the fistula is still patent. The low-velocity diastolic flow suggests an intracavernosal pressure similar to the diastolic arterial pressure. (d) Repeat angiogram shows that the fistula (arrowhead) is fed by contralateral vessels. The right cavernosal artery has been obliterated.

View larger version (173K): [in a new window]   Figure 6c.  High-flow priapism. (a) Sagittal color Doppler image shows an arterial-lacunar fistula in the right corpus cavernosum. (b) Angiogram shows the fistula (arrowhead), which is fed by the right cavernosal artery. After embolization, the penis remained tumescent. (c) Duplex US image shows high-velocity, turbulent flow, which indicates that the fistula is still patent. The low-velocity diastolic flow suggests an intracavernosal pressure similar to the diastolic arterial pressure. (d) Repeat angiogram shows that the fistula (arrowhead) is fed by contralateral vessels. The right cavernosal artery has been obliterated.

View larger version (210K): [in a new window]   Figure 6d.  High-flow priapism. (a) Sagittal color Doppler image shows an arterial-lacunar fistula in the right corpus cavernosum. (b) Angiogram shows the fistula (arrowhead), which is fed by the right cavernosal artery. After embolization, the penis remained tumescent. (c) Duplex US image shows high-velocity, turbulent flow, which indicates that the fistula is still patent. The low-velocity diastolic flow suggests an intracavernosal pressure similar to the diastolic arterial pressure. (d) Repeat angiogram shows that the fistula (arrowhead) is fed by contralateral vessels. The right cavernosal artery has been obliterated.

View larger version (184K): [in a new window]   Figure 7a.  High-flow priapism. (a) Sagittal color Doppler image shows an arterial-lacunar fistula due to rupture of the right cavernosal artery (arrowheads). (b) Angiogram shows the fistula (arrowhead), which was embolized. (c) Sagittal color Doppler image obtained soon after angiography shows that the right cavernosal artery (arrowheads) and fistula are still patent. At clinical evaluation, the penis remained tumescent. (d) Repeat angiogram shows recanalization of the right cavernosal artery and patency of the fistula (arrowhead). Repeat embolization was successful.

View larger version (210K): [in a new window]   Figure 7b.  High-flow priapism. (a) Sagittal color Doppler image shows an arterial-lacunar fistula due to rupture of the right cavernosal artery (arrowheads). (b) Angiogram shows the fistula (arrowhead), which was embolized. (c) Sagittal color Doppler image obtained soon after angiography shows that the right cavernosal artery (arrowheads) and fistula are still patent. At clinical evaluation, the penis remained tumescent. (d) Repeat angiogram shows recanalization of the right cavernosal artery and patency of the fistula (arrowhead). Repeat embolization was successful.

View larger version (193K): [in a new window]   Figure 7c.  High-flow priapism. (a) Sagittal color Doppler image shows an arterial-lacunar fistula due to rupture of the right cavernosal artery (arrowheads). (b) Angiogram shows the fistula (arrowhead), which was embolized. (c) Sagittal color Doppler image obtained soon after angiography shows that the right cavernosal artery (arrowheads) and fistula are still patent. At clinical evaluation, the penis remained tumescent. (d) Repeat angiogram shows recanalization of the right cavernosal artery and patency of the fistula (arrowhead). Repeat embolization was successful.

View larger version (211K): [in a new window]   Figure 7d.  High-flow priapism. (a) Sagittal color Doppler image shows an arterial-lacunar fistula due to rupture of the right cavernosal artery (arrowheads). (b) Angiogram shows the fistula (arrowhead), which was embolized. (c) Sagittal color Doppler image obtained soon after angiography shows that the right cavernosal artery (arrowheads) and fistula are still patent. At clinical evaluation, the penis remained tumescent. (d) Repeat angiogram shows recanalization of the right cavernosal artery and patency of the fistula (arrowhead). Repeat embolization was successful.

View larger version (87K): [in a new window]   Figure 8a.  High-flow priapism. (a) Duplex US image shows a cavernosal-lacunar fistula in the left corpus cavernosum. (b) Duplex US image obtained 9 hours after embolization shows that the left cavernosal artery is obliterated at the base of the penis (*). This appearance indicates that the embolization was successful, but the fistula is still patent. The fistula is fed by the left cavernosal artery (arrowheads), which is patent at the middle shaft with retrograde flow. (c) Sagittal color Doppler image shows that the patent portion of the cavernosal artery (CA) is fed by an arterial communication (arrow) with the dorsal artery (DA).

View larger version (157K): [in a new window]   Figure 8b.  High-flow priapism. (a) Duplex US image shows a cavernosal-lacunar fistula in the left corpus cavernosum. (b) Duplex US image obtained 9 hours after embolization shows that the left cavernosal artery is obliterated at the base of the penis (*). This appearance indicates that the embolization was successful, but the fistula is still patent. The fistula is fed by the left cavernosal artery (arrowheads), which is patent at the middle shaft with retrograde flow. (c) Sagittal color Doppler image shows that the patent portion of the cavernosal artery (CA) is fed by an arterial communication (arrow) with the dorsal artery (DA).

View larger version (187K): [in a new window]   Figure 8c.  High-flow priapism. (a) Duplex US image shows a cavernosal-lacunar fistula in the left corpus cavernosum. (b) Duplex US image obtained 9 hours after embolization shows that the left cavernosal artery is obliterated at the base of the penis (*). This appearance indicates that the embolization was successful, but the fistula is still patent. The fistula is fed by the left cavernosal artery (arrowheads), which is patent at the middle shaft with retrograde flow. (c) Sagittal color Doppler image shows that the patent portion of the cavernosal artery (CA) is fed by an arterial communication (arrow) with the dorsal artery (DA).