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This previously healthy 39-year-old man presented with congestive heart failure of recent onset.
Twenty years before manifesting heart failure, this patient sustained a stab wound to his neck. He recovered on hisown and remained well until the current illness began.
Even without that history, the size and tortuosity of the neck vein displayed in the image strongly suggested an AVfistula. A palpable thrill and a continuous murmur were evident over thevein. Moreover, compressing the vein abolished the murmur and decreased the heart rate from 110 beats/min to 80 beats/min (Branham’s sign). An arteriogramshowed a connection between the right external carotid artery and the right external jugular vein. Surgical closure of the fistula resulted in resolution ofthe patient’s high-output heart failure.
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