An unusual pulmonary condition presenting following trauma.

An 18-year-old man presented to the emergency department following an assault. He complained of left-sided pleuritic chest pain and difficulty breathing. Clinical examination revealed reduced air entry and coarse crepitations at the left lung base. A chest x-ray showed a large opacity at the left lung base that contained multiple cystic areas with air-fluid levels. Due to the history of trauma, a provisional diagnosis of a ruptured hemidiaphragm with small bowel herniation was made. Further imaging, including ultrasound, spiral computed tomography and magnetic resonance angiography, showed an aberrant vessel supplying the opacity and drainage into the pulmonary venous system. A diagnosis of a bronchopulmonary sequestration (intralobar type) was made. The differential diagnosis of the radiographic appearance is also discussed.

Pseudo-aneurysm of the anterior tibial artery, a rare cause of ankle swelling following a sports injury.

BACKGROUND: Ankle pain and swelling following sports injuries are common presenting complaints to the accident and emergency department. Frequently these are diagnosed as musculoskeletal injuries, even when no definitive cause is found. Vascular injuries following trauma are uncommon and are an extremely rare cause of ankle swelling and pain. These injuries may however be limb threatening and are important to diagnose early, in order that appropriate treatment can be delivered. We highlight the steps to diagnosis of these injuries, and methods of managing these injuries. It is important for clinicians to be aware of the potential for this injury in patients with seemingly innocuous trauma from sports injuries, who have significant ankle pain and swelling. CASE PRESENTATION: A young, professional sportsman presented with a swollen, painful ankle after an innocuous hyper-plantar flexion injury whilst playing football, which was initially diagnosed as a ligamentous injury after no bony injury was revealed on X-Ray. He returned 2 days later with a large ulcer at the lateral malleolus and further investigation by duplex ultrasound and transfemoral arteriogram revealed a Pseudo-Aneurysm of the Anterior Tibial Artery. This was initially managed with percutaneous injection of thrombin, and later open surgery to ligate the feeding vessel. The patient recovered fully and was able to return to recreational sport. CONCLUSION: Vascular injuries remain a rare cause of ankle pain and swelling following sports injuries, however it is important to consider these injuries when no definite musculo-skeletal cause is found. Ultrasound duplex and Transfemoral arteriogram are appropriate, sensitive modalities for investigation, and may allow novel treatment to be directed percutaneously. Early diagnosis and intervention are essential for the successful outcome in these patients.

Loss of testicular volume associated with intratesticular varicocele.

Intratesticular varicocele is a rare entity and its clinical significance is not well established. We report a case of left-sided intratesticular varicocele associated with a significant reduction in left testicular volume at follow up. This association has not been previously reported. Incidentally, our patient is also the youngest case reported in the literature to date.