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Corpora cavernosal infarction

Case contributed by Ashesh Ishwarlal Ranchod
Diagnosis certain

Presentation

The patient presents with permanent erectile dysfunction. History of priapism 3 years back.

Patient Data

Age: 40 years
Gender: Male
mri

There is inhomogeneous T1, T2, and STIR signal intensity in the corpora cavernosa.

Features suggest chronic corpora cavernosal infarction, right greater than left.

There is associated fibrosis and fatty infiltration of the corpora cavernosa.

The corpus spongiosum, tunica albuginea, and penile septum were normal.

mri

Dynamic post-contrast imaging was performed for up to 20 minutes without the use of any intracavernosal injection.

These images show non-enhancing regions within the corpora cavernosa, right greater than left, consistent with chronic infarction.

(Motion artifact was unavoidable).

ultrasound

These limited ultrasound images confirm the inhomogeneous echogenicity and echotexture of the corpora cavernosa, compatible with fibrosis and fatty infiltration.

The penile septum, tunica albuginea, and corpora spongiosum have a normal appearance.

 

Case Discussion

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.

 

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