[Paradoxical pulmonary embolism. A rare complication of arteriovenous fistulization of an aorto-iliac aneurysm].

Aneurysms of the infra-renal abdominal aorta or iliac arteries result in ilio-caval compression in about 10% of cases which may cause venous thrombosis by stasis and pulmonary embolism. Fistulisation of these aneurysms into the inferior vena cava or an iliac vein is rare and paradoxical pulmonary embolism from arterial thrombus of the aneurysmal pouch is exceptionally rare. The authors report a new case in which the ilio-iliac arteriovenous fistula caused high output cardiac failure, ischaemia of the homolateral leg and pulmonary embolism. Doppler ultrasonography diagnosed the fistula and excluded a deep vein thrombosis. This case illustrated the essential value of clinical examination and of Doppler ultrasonography, especially of the abdomen, in the investigation of the causes of pulmonary embolism.