Spontaneous arteriovenous fistula of left internal iliac artery aneurysm

A 52-year-old man with a history of hypertension presented with a sudden onset of swelling in the left thigh and dyspnoea on exertion. His hypertension was well controlled with amlodipine, and he had no other clinically relevant medical history. On examination, the blood pressure was 108/66 mmHg, the pulse 100bpm, the respiratory rate 16 breaths per minute, and the oxygen saturation 97% (ambient air). A pulsatile mass with a continuous murmur was palpable in his left lower abdominal quadrant. Chest X-ray showed mild pulmonary congestion without cardiomegaly. …