0:00

Okay. For our next case, it's a great example to show that things can

0:04

coexist. So this person has arteriovenous

0:08

fistula as well as a pseudoaneurysm, and we're going to look at all our imaging

0:12

to ascertain this diagnosis.

0:14

In this young person, you can see that there is no significant atherosclerosis, and

0:18

we're going to scroll all the way down to the area of interest.

0:22

Already, you can see that there's early enhancement of the right

0:26

superficial femoral vein compared to that contralateral side.

0:29

It's also dilated in size and really has that

0:33

same degree of opacification as the arteries.

0:36

So key things in an arteriovenous fistula, as we've seen in the prior scan,

0:40

is asymmetric enhancement of a vein.

0:44

That vein is dilated, and because of that shunting and that

0:48

communication, the degree of opacification and enhancement in that

0:51

vein matches that of the artery.

0:55

So as I'm scrolling down here, looking at that popliteal artery and that popliteal

0:59

vein, and scrolling all the way down here,

1:03

we see that anterior tibial artery, and a

1:06

large pseudoaneurysm,

1:09

as well as small fistulous

1:13

connections with that anterior tibial vein that are there.

1:17

There's also early drainage of the

1:21

vein right here into that popliteal vein.

1:24

So multiple sites

1:27

of this popliteal artery, proximal anterior tibial artery

1:31

pseudoaneurysm, and arteriovenous fistula right here.

1:36

So things can coexist. We can have an arteriovenous fistula in

1:40

combination with a pseudoaneurysm.

1:42

Sometimes you can see pseudoaneurysm as an active bleed, and so

1:45

really avoid satisfaction of search.

1:48

Now, we could have just looked at this and said, "Okay, there's a large

1:52

arteriovenous fistula" and been done.

1:54

But I think it's really important to note that one of the most important clues,

1:58

even when you don't see a direct communication between an artery and a vein, is

2:02

just the early enhancement of the vein.