A 15-year-old male was referred to the vascular lab after sustaining blunt penile trauma during a bicycle accident. There was clinical concern for an arterial leak into the cavernosum causing partial priapism. An outside ultrasound demonstrated a vascular anomaly.
A penile duplex utilizing a Siemens Antares with a 12 MHz linear transducer was performed. All penile vasculature was interrogated with color and pulsed Doppler assessing for flow state; the penile tissue was assessed with gray scale to identify any soft tissue injury.
Gray scale, color imaging and spectral Doppler identified an arterial injury involving the cavernosal artery resulting in a AV-fistula resembling a pseudoaneurysm measuring 0.75 cm AP x 1.05 cm transverse and 1.61 cm long. High volume low resistant waveforms were identified with spectral Doppler at the connection to the mid cavernosal artery.
Gray scale, color imaging and spectral Doppler was used as a valuable tool in the identification of a corporal artery AV-fistula. The pericavernosal AV-fistula has the appearance of a pseudoaneurysm but due to the highly vascularized cavernosum, physiologically acts like an AV-fistula. Blood leaking from the artery into the pseudoaneurysm is absorbed into the venous system through the cavernosum rather than being pulled back into the artery. The referring urologist reviewed the images of this study and determined that this penile injury is amenable to treatment. The injury was successfully treated with endovascular angioembolization. Post-procedure ultrasound showed no evidence of corpuscavernosum arteriovenous fistula. This type of injury appears to be a rare finding by ultrasound, but thorough imaging techniques can assist the physician in diagnosis and treatment.
Jeremy Payne, Michigan Medicine University of Michigan