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A healthy 24-year-old male patient presented with a history of straddle-trauma from a bicycle accident and concomitant non-ischemic-priapism lasting for ten days. On a contrast-enhanced computed tomography scan an arterio-cavernous fistula establishing a connection between the right cavernosal artery and the ipsilateral corpus cavernosum was diagnosed. Super-selective unilateral arterial embolization was performed using gelatin sponge and microcoils. Technical success became evident with the consecutive detumescence of the penis and long-term preservation of baseline urogenital functions.

Background The goal of our analysis is to provide technical information and clinical long-term data on arterial embolization for non-ischemic priapism. Furthermore, this study presents a comprehensive literature review. Methods We analyzed patient data from June 2005 to June 2025 at a large university hospital, focusing on patients with non-ischemic priapism lasting over 1 week, unresponsive to conservative treatment, and referred for arterial embolization. Age, symptom etiology, initial diagnostic modality, embolic agent, uni- or bilateral arterial supply of the fistula/pseudoaneurysm, technical success, clinical outcome, need for a second attempt, erectile dysfunction, adverse events, and mean follow-up time needed were assessed. Findings were contextualized with studies from the past two decades. Results A total of 15 male patients with non-ischemic priapism due to blunt, penetrating trauma or of idiopathic origin, were included in this analysis. The embolic agents chosen included gelatin sponge, polyvinyl alcohol particles, autologous clot, microcoils, and a combination of microcoils with gelatin sponge or polyvinyl alcohol particles. Technical success was achieved in 14 patients (93.3%). A second or third intervention was needed in three cases (20.0%) to achieve clinical success. Documented adverse events included procedure-related findings such as penile skin changes and deviation in two patients (13.3%). No new cases of erectile dysfunction were reported (0%). Conclusion Our findings support super-selective arterial embolization as a safe, technically successful, and minimally invasive therapy option for non-ischemic priapism after conservative measures fail. Moreover, our data suggest that arterial embolization is associated with long-term symptom improvement without significantly impairing sexual function. Graphical Abstract

Objectives Escape rooms provide an interactive learning experience, combining clinical knowledge with problem-solving and teamwork. A radiology-themed escape room has been organized at the European Congress of Radiology in 2019 and 2023–2025, with over 900 people participating in total. The process of developing a radiology-themed escape room is discussed, and the results of a participant survey are presented. Materials and methods The development of a radiology-themed escape room was based on five steps. Initially, an overarching concept was chosen, then multiple puzzle ideas were brainstormed. These were linked together to form a story, and then fully developed with relevant images and materials. Finally, the room was tied together, and a fitting atmosphere was created. Participants in 2025 were asked to complete a survey with questions on their training status, the challenges that they found most difficult, and their thoughts on the activity as a learning tool and for improving teamwork. Results Three different concepts of radiology-themed escape rooms were developed for the congresses from 2019 to 2025. The overarching concepts were a polytrauma situation, a thrombectomy for fulminant pulmonary embolism, and a tumor board, respectively. Two hundred ninety people participated in 2025, and 149 completed the exit survey; 66.7% of participants were able to complete the room in time. Enjoyment, learning, and team building were all rated highly by participants. Conclusion A development process for designing a radiology-themed escape room is presented. A prior implementation shows an enjoyable and educational experience for radiologists and other medical professionals. Critical relevance Insights are given on the development of a radiology-themed escape room, providing a unique interactive learning opportunity for residents that incorporates image interpretation with teamwork and cognitive puzzles, resulting in an enjoyable educational experience. Key Points A step-by-step guide on developing a radiology-themed escape room is presented. Radiological escape rooms provide an enjoyable, educational, and team-building experience. Interactive learning experiences could play a larger role in modern radiology education. Graphical Abstract

ObjectivesAnatomical variation of the sacroiliac (SI) joints is common and specific variants are associated with erosions and bone marrow oedema on imaging. Our investigation aims to evaluate whether anatomical variations influence the clinical presentation of axial spondyloarthritis (axSpA).MethodsIn this propensity score matched post hoc analysis documented clinical data from four prospective clinical cohorts was assessed. Classification of back pain as inflammatory (=IBP), human leucocyte antigen-B27 positivity, family history, disease activity according to Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), symptom duration, elevated acute phase reactants, peripheral and extramusculoskeletal manifestations were evaluated. Statistical analyses were done using (generalised) linear models, t-tests, χ2 tests and analysis of variances. Multiple testing was corrected according to Bonferroni.ResultsA total of 165 patients (86 women) were included. Atypical SI joints, defined by the presence of accessory joint facets, iliosacral complex or crescent-shaped ilii on MRI, were identified in 61 out of 165 patients with axSpA. Disease activity, assessed by BASDAI and symptom duration were similar in both groups (adjusted ß=−0.118 (95% CI -0.713, 0.476), p=0.696 and 120.0 (107.4) vs 116.5 (98.3) months, p=0.838, respectively). There was no significant difference in IBP between the groups (adjusted OR=0.614 (95% CI 0.274, 1.377), p=0.236). Sex-stratified analysis revealed no statistically significant results.ConclusionOur analysis suggests that clinical phenotypes do not significantly differ between patients with axSpA with and without atypical joints.