Two vessels, two lesions: bilateral traumatic independent carvernosal artery pseudoaneurysms presenting with high-flow priapism: a case report

Abstract Background High-flow priapism (HFP) secondary to traumatic cavernosal artery pseudoaneurysm is a well-documented but uncommon urological emergency. While unilateral pseudoaneurysms are reported, bilateral pseudoaneurysms fed independently by both the left and right cavernosal arteries represent an exceptionally rare vascular etiology. Case presentation This case report documents a 27-year-old male who developed painful, persistent erection six days after sustaining a straddle injury from a motorcycle hitting a pothole. Penile doppler ultrasound and computed tomography angiography (CTA) confirmed the diagnosis of bilateral cavernosal artery pseudoaneurysms, with each lesion supplied by its respective ipsilateral cavernosal artery. This anatomical configuration is seldom described in the literature. Conclusion The case highlights the critical role of timely multimodal imaging in diagnosis, highlights the unique management considerations for bilateral independent feeders, and discusses the implications for long-term erectile function. Lack of specilaized equipment at the time, precluded confirmatory digital subtraction angiography (DSA), a limitation that reflects real-world challenges in resource-limited settings.