Unilateral cutaneous congestion induced by Valsalva manoeuvre due to vascular malformation

Description

A man aged 37 years presented with hip osteoarthritis with avascular femoral head necrosis due to chronic alcohol use. He had spinal arteriovenous fistula (AVF) which was diagnosed with spinal angiography (figure 1A, B) and spinal MRI (figure 2) 30 years prior. The lesion was not completely treated by surgical intervention at that time. On examination, Valsalva manoeuvre showed a reversible and rapid change in colour of his unilateral chest wall (figure 3A, B and video 1). Contrast-enhanced CT of the chest on the same location revealed cutaneous vascular malformation (figure 4). The dermatome level exactly also corresponded to the dermatome level of spinal AVF.

Figure 1

Spinal angiography revealed spinal arteriovenous fistula (AVF) (A) before and (B) after.

Figure 2

Spinal MRI showed spinal arteriovenous fistula.

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