High-flow priapism in acute lymphatic leukaemia

Pediatr Radiol (2004) 34: 560563DOI 10.1007/s00247-003-1124-1 CASE REPORT

Hans-Joachim Mentzel Karim Kentouche Claus Doerfel Susanna Vogt Felix ZintlWerner A. Kaiser

High-ow priapism in acute lymphatic leukaemia

Received: 25 September 2003 Revised: 10 November 2003 Accepted: 16 November 2003 Published online: 14 January 2004 Springer-Verlag 2004

Abstract Priapism is dened as prolonged and persistent erection of the penis without sexual stimulation. It is associated with excessive hyperleukocytosis (e.g. in acute or chronic leukaemia); however, this complication is rarely seen in the pediatric population. We report a 12-year-old boy suering from acute leukaemia presenting with, at rst intermittent, but increasingly persistent erection. Doppler US revealed signs of high-ow priapism. MRI excluded intrapelvic tumour masses, and three-dimensional contrast-enhanced MR angiography could not demonstrate an arteriovenous stula or thrombosis. Cavernosal blood-gas measurement was in agreement

with high-ow priapism. On the basis of the imaging ndings, invasive therapeutic management was avoided in our patient with a successful outcome.

Keywords Penis Priapism

Leukaemia Ultrasound

MRI MRA Children

H.-J. Mentzel (&) S. Vogt W. A. Kaiser Institute of Diagnostic and Interventional Radiology, Department of Pediatric Radiology, Friedrich-Schiller-Universitat Jena, Bachstrae 18, 07740 Jena, Germany E-mail: [e-mail].: [phone]Fax: [phone]

K. Kentouche C. Doerfel F. Zintl Department of Paediatrics, University of Jena, Germany

Introduction Priapism is dened as abnormal and prolonged erection of the penis that is not associated with sexual excitement and is caused by disturbances in the mechanisms controlling penile detumescence and maintenance of penile accidity [1]. Priapism frequently results in erectile failure and is considered a urological emergency. It can be classied into high-ow and low-ow states. The distinction of high-ow versus low-ow priapism is relevant to treatment because selective arterial embolisation of the internal pudendal or cavernosal artery is considered the rst-line management of high-ow arterial priapism in cases with arteriovenous stula [2]. Perineal or penile trauma is the most common cause of painless priapism. Low-ow priapism may be caused by

veno-occlusive problems, for example in patients with sickle cell anaemia or chronic myeloid leukaemia. Preservation of normal erectile function is a major goal in the management of priapism. Improper treatment may result in impotence. The overall impotence rate after priapism can be as high as 59% [3]. We describe the use of non-invasive imaging for the determination of high-ow...