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Diagnosis of spontaneous aorto-caval fistula by computed tomography.

Spontaneous aorto-caval fistulae are an uncommon complication of abdominal aortic aneurysms. The diagnosis may not be apparent at the initial clinical examination, as the fistulae have variable clinical features. Arteriography has been used to establish this diagnosis (Dardik et al, 1976; Fyfe et al, 1978; Gregson et al, 1983). We report a case in which the diagnosis was established by computed tomography (CT). This is believed to be the first report of this condition shown by CT. A previously fit 67-year-old male presented with a 4-day history of chest pains, dyspnoea and dizziness. On examination he appeared unwell, with a blood pressure of 100/60 mmHg and a regular pulse rate of 100 per min. There was a large, pulsatile abdominal mass with a bruit over it. The peripheral pulses were normal and there was no ankle oedema; the feet, however, were cyanosed.