THE INTERESTING hemodynamic effects which may be produced by large abnormal communications between arteries and veins long have held the interest of physicians. More recently it has been recognized that bacteremia and a clinical picture indistinguishable from bacterial endocarditis can result when an arteriovenous (AV) communication becomes infected.1 The case to be reported is of interest from several points of view: (1) it involved an AV fistula between the renal artery and inferior vena cava, a rather unusual location; (2) the mode of presentation was confusing; (3) the patient provided a number of clinical clues which finally led to the correct diagnosis; (4) treatment was successful.
Report of Case
A 36-year-old male professional gambler was admitted to the King County Hospital on Feb 26, 1965. Two weeks prior to admission he had developed fever and malaise. Twenty-one months earlier, during a game of cards, he had sustained a gunshot