| Abstract: | Collective experience at the Mayo Clinic with nine cases of acquired aortocaval fistula revealed a difference between the presenting features of patients with traumatic fistula and those of patients with spontaneous fistula. In addition, patients with spontaneous aortocaval fistula, rather than presenting with a single distinct clinical syndrome, present with at least three different clinical pictures: (1) the classic syndrome of high-output heart failure of recent onset with palpable aneurysm and continuous bruit, (2) hypotension and oliguria or anuria in the presence of an abdominal aortic aneurysm, which may not be tender and in which a characteristic bruit may be absent and (3) back pain or abdominal pain associated with a tender pulsatile mass, shock and retroperitoneal hemorrhage. (The fistula may not be suspected prior to surgery.) |
