Delayed presentation of a rare and complex multi-vessel pulmonary arteriovenous fistula following penetrating chest-wall trauma.

The formation of a pulmonary arteriovenous malformation (PAVM) following penetrating chest trauma is a rare occurrence, often rapidly fatal or requiring emergency surgery. Even rarer still, is for the malformation to formed by an entangled and grossly tortuous network of multiple arteries and veins, with symptoms and eventual presentation to a medical facility taking place years after the initial injury. Without substantial literature available, and nil regarding instances of more than one involved artery and vein, we present the case of a complex left-sided PAVM, becoming symptomatic 15 years after a chest-wall stabbing. Clinical examination revealed hypoxia, tachycardia and an extracardiac bruit-prompting delineation with a computed tomography pulmonary angiogram and revealing the PAVM. Subsequent attempt at endovascular embolization was unsuccessful, though interrogation provided vital planning information for workup of urgent open-surgical ligation and resection. Surgery carries high morbidity and mortality, as does natural progression if left undealt.

A rare case of post-traumatic high-flow priapism requiring endovascular salvage with bilateral superselective microcoil embolization.

Post-traumatic high-flow priapism is a rare occurrence, with potentially debilitating long-term erectile dysfunction if left unaddressed. Even rarer, however, is for the priapism symptoms to be caused by a single cavernosal arterial pseudoaneurysm, with feeding vessels from the distal branched vessels of 'both' the left and right internal pudendal arteries. To the best of our knowledge, we present the first documented case of endovascular salvage utilizing superselective microcoil embolization in the treatment of high-flow priapism caused by a singular pseudoaneurysm with bilateral inflow. Timing of symptoms, interpretation of imaging, multidisciplinary discussions, procedural risk, arterial anatomy and choice of embolic agent were all careful considerations in this case. Following embolization, this young gentleman ultimately had a successful angiographic result, normalization of his cavernosal artery peak systolic velocity on ultrasound and a full return to normal erectile function by 6 months.