Cutaneous manifestations of abdominal arteriovenous fistulas

Abdominal arteriovenous (A-V) fistulas may be spontaneous or secondary to trauma. The clinical manifestations of abdominal A-V fistulas are variable, but cutaneous findings are common and may be suggestive of the diagnosis. Cutaneous physical examination findings consistent with abdominal A-V fistula include lower extremity edema with cyanosis, pulsatile varicose veins, and scrotal edema. We present a patient admitted to the hospital with lower extremity swelling, discoloration, and pain, as well as renal insufficiency. During a prior hospitalization she was diagnosed with venous stasis dermatitis; however, her physical examination findings were not consistent with that diagnosis. Imaging studies identified and characterized an abdominal aortocaval fistula. We propose that dermatologists add abdominal A-V fistula to the differential diagnosis of patients presenting with lower extremity edema with cyanosis, and we summarize other physical examination and laboratory findings that may suggest the diagnosis.