Traumatic arteriovenous fistula of the internal mammary artery

A rare case of arteriovenous fistula of the left internal mammary artery after blunt chest trauma is described. The patient was seen 3 weeks later because of a pulsating mass which varied in size, over the left midsternal area. Aortography and arteriography showed an aneurysmal sac draining into a vein in the left chest wall and then into the left axillary and neck veins. The fistula was ligated and excised followed by complete recovery. The literature is reviewed and differential diagnosis from congenital heart conditions, A-V shunts of other thoracic wall vessels, and vascular tumors is discussed.