50 years old man with a pulsatile neck mass after

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Doctor's Information

Name :  Hamidreza
Family :Haghighatkhah
Affiliation : ----------------
Academic Degree: ----------------
Email :   This email address is being protected from spambots. You need JavaScript enabled to view it.
Resident :  Hussein Soleiman Tabar

Patient's Information

Gender : Male
Age : 50

Case Section

Interventional Radiology

Clinical Summary

50 years old man with a pulsatile neck mass after insertion of a central venous catheter.

Imaging Procedures and Findings

On image 1 simultaneous filling of left internal jugular vein during left internal carotid arteriogram represents presence of an A-V fistula. Image 2 clearly shows the fistulous tract. A pseudoaneurysm is also formed on it.

Discussion

The term Arteriovenous fistula is best limited to the condition where there is a single communication between an artery and a vein, and is mainly of traumatic origin, particularly following gunshot or other penetrating wounds. Occasionally it may result from a closed injury. Traumatic fistulas may occur anywhere in the body. Spontaneous arteriovenous fistula is also occasionally encountered, resulting from rupture of an aneurysm into an adjacent vein. A site of election for this is the cavernous sinus, where rupture of an aneurysm can give rise to pulsating exophthalmos. Another well-documented site is the abdominal aorta, where rupture of an aneurysm into the inferior vena cava leads to aortocaval fistula. Iatrogenic arteriovenous fistulas, apart from those deliberately induced for dialysis, can arise from many procedures, particularly orthopedic operations on the hip, ankle and spine. Aortocaval and ilioiliac fistulas have followed lumbar disc operations when the rougeur has been passed through the anterior spinal ligament, and renal arteriovenous fistula is a common complication of renal biopsy. Arteriography has given rise to arteriovenous fistula at the site of puncture, usually of small arteries (brachial and vertebral), but it has also been recorded in the femoral artery. Because of the grossly hypertrophied drainage veins carrying arterial blood, a fistula may be very difficult to locate at surgery, and prior angiography with localization of the fistula is essential. The dilated feeding artery fills early, as do the dilated drainage veins, and large amounts of contrast medium with rapid serial films are necessary to clearly define the anatomy and the site of the fistula. A large arteriovenous fistula throws an extra burden on the heart because of the large amount of shunt, and can result in cardiac failure from high cardiac output unless successfully treated. Many fistulas, particularly smaller ones, are now treated successfully by embolization.