DrAlex_76
Forum Guru
Topics: 120
Posts: 410
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5 yrs after being shot on the right thigh, a 21 yo man comes to ER because of buzzing sensation adjacent to the scar. At the time of the initial wound, he was discharged after 6 hrs of observation with no fractures or soft tissue swelling. A loud murmur is heard on auscultation , there is a thrill. He has dilated varicose vein with incompetent valves in the lower leg. Which of the following is the most likely diagnosis ?
A. Arterial spasm
B. AV fistula
C. DVT
D.Occlusion of the superficial femoral artery
E. Pseudoaneurysm
Please explain, thanks
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| wasedf
Forum Junior
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This seems to me a case of AV fistula. A complication that arises after trauma to the lower limb. It is possible that the bullet may have bruised the edges of the femoral artery and vein without causing visible soft tissue damage in the initial stages and 5 years later, a fistula forms.
As a side, when performing above knee amputation the femoral artery and femoral vein are ligated separately inorder to prevent AVfistula which may arise if the two vessels are tied together using the same suture. The two vessels are tied using non absorbable suture.
Coming back to our question, the other options don't seem to tie all the findings.
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| Eagle_303
Forum Guru
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100% agree with asedf :
The blood running from high pressure artery to low pressure vein causes Murmur and thrill at the level of lesion.
Due to excessive blood pressure in the femoral vein ,the venous return from the lower leg is restricted leading to dilated veins and incompetence of valves of veins due to dilation (varicose veins )
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| nightflight1945
banned
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Posts: 920
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B. AV fistula
A classic case of AV fistula .
The most important complication esp in large ones , is CHF .
The patient has high PR and wide PP in physical exam that are accentuated by pressure on the fistula.
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| Eagle_303
Forum Guru
Topics: 77
Posts: 655
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Yes nightflight you are right.
These patients are candidates with high output failure.
Paget's disease of the bones also leads to same consequences due to excessive AV fistulea fromation in the bones.
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| nightflight1945
banned
Topics: 32
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Thank you Eagle_303,
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| ngaybinhyen
Forum Guru
Topics: 23
Posts: 657
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classic one, one of the causes for high output failure
- Beri-Beri
- Pagets
- thyroid storm
- Av fistulae
- stimulant overdose
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