BMJ Case Reports 2017; doi:10.1136/bcr-2017-219625

Unilateral cutaneous congestion induced by Valsalva manoeuvre due to vascular malformation

  1. Taro Shimizu
  1. Dokkyo Medical University, Tochigi, Japan
  1. Correspondence to Dr Taro Shimizu, shimizutaro7{at}
  • Accepted 25 February 2017
  • Published 9 March 2017


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 …

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