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    This module is included inLens: Rice University Press Titles
    By: Rice University PressAs a part of collection:"Images of Memorable Cases: 50 Years at the Bedside"

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Images of Memorable Cases: Case 130

Module by: Herbert L. Fred, MD, Hendrik A. van Dijk. E-mail the authors

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Case_130-pres1-1.jpg

This previously healthy 39-year-old man presented with congestive heart failure of recent onset.

Twenty years before manifesting heart failure, this patient sustained a stab wound to his neck. He recovered on his own and remained well until the current illness began.

Even without that history, the size and tortuosity of the neck vein displayed in the image strongly suggested an AV fistula. A palpable thrill and a continuous murmur were evident over the vein. Moreover, compressing the vein abolished the murmur and decreased the heart rate from 110 beats/min to 80 beats/min (Branham’s sign). An arteriogram showed a connection between the right external carotid artery and the right external jugular vein. Surgical closure of the fistula resulted in resolution of the patient’s high-output heart failure.

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