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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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