A Case Report of Delayed Presentation of a Carotid-Jugular Fistula Caused by Blunt Injury from an Arrow

Background: Acquired arteriovenous fistulas (AVFs) are most commonly caused by direct arterial trauma, with 90% of traumatic AVFs due to penetrating trauma. Post-traumatic common carotid artery-internal jugular vein fistulae are rare, with an incidence of 4% to 7% of all traumatic AVFs.

Case report: We present a case of delayed presentation of a patient with shortness of breath, neck pain, and worsening right upper extremity paresthesias 10 days after a blunt injury to the neck by an arrow. He was subsequently found to have a common carotid artery-internal jugular vein fistula and a common carotid pseudoaneurysm on computed tomography angiography. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Post-traumatic common carotid-jugular AVFs are uncommon, especially in patients with delayed presentations and a blunt injury mechanism. If left untreated, AVFs may progress to high-output cardiac failure, atrial fibrillation, and embolization. Clinicians must be aware of this finding, given the potential for significant morbidity.