Introduction: The authors present a case of an aortocaval fistula manifesting clinically with bilateral long saphenous bruits. This sign has not been previously described.
Report: An 85-year old lady presented with a 3-week history of abdominal pain radiating to her back. Examination revealed a bruit to the right of the midline associated with bilateral long saphenous bruits. A provisional diagnosis of an aortocaval fistula was confirmed on computerised tomography. The fistula was excluded by aortobiiliac bypass and the patient made an uneventful recovery.
Discussion: Aortocaval fistulae are rare. They should be suspected if abnormal pulsations are felt to the right of the midline in association with bruits in the region of the inferior vena cava. The presence of long saphenous bruits suggests saphenofemoral incompetence due to arterialised, reversed venous flow dynamics and strengthens the clinical diagnosis of aortocaval fistula.
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