Congenital Vertebral Arteriovenous Fistula

To the Editor:—  The presence of an arteriovenous communication is usually obvious on physical examination. When the continuous murmur and palpable thrill of such a communication are noted, the diagnosis is easily made. The localization of the fistula, however, is often a more difficult task. When a bruit and thrill are present in the neck, the differential diagnosis includes local arterial disorders as well as central or cardiac disorders that may transmit sound and energy distally to the cervical vessels. Probably as a result of their rather uncommon occurrence, congenital fistulas of the vertebral system are not considered in the differential diagnosis of such disorders. We report an example of a congenital arteriovenous fistula of the vertebral system which was initially thought to be a patent ductus arteriosus.

Report of a Case:—  A 23-year-old white man was admitted to the hospital for diagnostic studies in May 1968. The patient was