Unusual Presentation and Identification of a Post-traumatic Arteriovenous Fistula Identified with the Use of Duplex Ultrasonography

Abstract

Case Report A 49-year-old athletic male presented with a 3-year history of unrelenting left lower-extremity edema after a motor vehicle accident. He underwent a venous duplex ultrasound, which revealed distal left superficial femoral and popliteal deep venous thrombosis and multiple venous collaterals with arterial Doppler signals within the thrombus and vein wall at the level of the popliteal fossa. Doppler waveforms were highly suspicious for an arteriovenous fistula (AVF). Direct auscultation of the popliteal fossa revealed a continuous bruit. Magnetic resonance arteriography revealed early venous filling of the left femoral vein with multiple dilated veins in the region of the popliteal artery, consistent with AVF. The patient underwent surgical interruption of the AVF with significant resolution of the lower extremity edema. Conclusion In our experience, unusual Doppler waveform characteristics and multiple collateral vessels should alert the sonographer to the possibility of an AVF. This report exemplifies the role of Doppler ultrasound in the diagnosis of unrelenting and unexplained lower extremity edema.