Abstract
A spontaneous aortocaval fistula is a rare complication of abdominal aortic aneurysms. In 50 percent of the patients, it presents with the classic signs of a pulsatile abdominal mass, continuous bruit, and low back pain. A high degree of clinical suspicion and a well-performed physical examination are important for its timely diagnosis.
Highlights
The prevalence of aortocaval fistulas is one percent of all abdominal artery aneurysms [1], but the variety of clinical presentations makes early diagnosis challenging [2,3]
We report a case of a spontaneous iliac artery-to-iliac vein fistula presenting with symptoms suggestive of deep venous thrombosis, recurrent pulmonary embolism, and right heart failure
A computed tomography (CT) angiography revealed a fusiform aneurysm at the level of the distal abdominal aorta and iliac arteries measuring up to 8.0 x 8.5 cm in the greatest transverse dimension complicated by a spontaneous arterio-venous fistula between the right iliac artery and the left iliac vein
Summary
The prevalence of aortocaval fistulas is one percent of all abdominal artery aneurysms [1], but the variety of clinical presentations makes early diagnosis challenging [2,3]. We report a case of a spontaneous iliac artery-to-iliac vein fistula presenting with symptoms suggestive of deep venous thrombosis, recurrent pulmonary embolism, and right heart failure. A 62-year-old male with hypertension and a smoking history of 50 packs a year was seen in the emergency department, complaining of dyspnea on exertion, fatigue, early satiety, and abdominal discomfort His blood pressure was 130/70 mm Hg, heart rate was 120/min and regular, lower extremity edema (left more than right) up to his knees was noted. A computed tomography (CT) angiography revealed a fusiform aneurysm at the level of the distal abdominal aorta and iliac arteries measuring up to 8.0 x 8.5 cm in the greatest transverse dimension complicated by a spontaneous arterio-venous fistula between the right iliac artery and the left iliac vein Coronal, and sagittal oblique computed tomography angiography (CTA) images through the pelvis demonstrate a fistulous tract (arrows) between an aneurysmal dilatation of the right common iliac artery and the adjacent left common iliac vein with early enhancement of the latter
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