High-output heart failure following gunshot injury and traumatic arteriovenous fistula.

Abstract

Heart failure due to high cardiac output rarely occurs. Few cases of post-traumatic arteriovenous fistula (AVF) as a cause of high-output failure were reported in the literature. Herein, we report a case of 33-year-old male who was admitted to our institution due to symptoms of heart failure. He reported a gunshot injury of the left thigh 4months earlier, when he had been shortly hospitalized and discharged 4days later. Since the gunshot injury he had exertional dyspnea and left leg edema, so the diagnostic procedures were performed. Clinical examination revealed distended neck veins, tachycardia, slightly palpable liver, left leg edema, and thrill over the left thigh. Due to high clinical suspicion, duplex ultrasonography of the left leg was performed that verified femoral AVF. Operative treatment of AVF was made with prompt resolution of symptoms. This case wants to emphasize the importance of proper clinical examination, and duplex ultrasonography in all cases of penetrating injuries.