Traumatic peri-renal AV fistula presenting with pulmonary hypertension and right-side heart failure

We describe a 47-year-old male patient who presented with symptomatic pulmonary hypertension in association with traumatic peri-renal arteriovenous (AV) fistulae. He developed symptoms and clinical evidence of pulmonary hypertension, and high-output right heart failure long after a left flank stabbing injury 16 years ago. Numerous AV fistulae were illustrated around the atrophic left kidney by spiral computed tomography. Although acquired systemic AV fistula has been implied in the substrates of pulmonary hypertension, association with traumatic AV fistula in the peri-renal region has not been reported previously.