CTICasesIntercostal Artery to Azygos Vein Fistula
Imaging findings
Contrast-enhanced CT demonstrates multiple tortuous, dilated, and hypervascular arterial structures in the posterior thoracic wall, arising from a branch of an intercostal artery. These vessels feed directly into a massively dilated azygos vein, indicating a high-flow arteriovenous fistula. Similar, albeit milder, hypervascularity is noted on the contralateral side.
Key takeaways
Arteriovenous fistulas between the intercostal arteries and the azygos system are rare vascular anomalies that can be congenital or acquired (such as post-traumatic). They can lead to high-output cardiac failure and progressive dyspnea. Transcatheter embolization is a highly effective treatment option to close the shunt and relieve symptoms.
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