Work

Salmonella Aortitis–Induced Aortocaval Fistula Masquerading as Tricuspid Disease

Year: 2025

Type: article

Abstract: BACKGROUND: Aorto-caval fistula (ACF) is a rare complication of infectious aortitis and an uncommon cause of high-output right heart failure. CASE SUMMARY: A 61-year-old man presented with systemic congestion and severe tricuspid regurgitation after recent Salmonella septicemia. Echocardiography showed right ventricular enlargement and hepatic vein systolic flow reversal. Right heart catheterization revealed elevated inferior vena cava oxygen saturation (88.8%), suggesting a systemic to venous shunt. Doppler ultrasound confirmed an ACF from the right common iliac artery to the inferior vena cava. The patient underwent successful endovascular aortic repair after antibiotic therapy, resulting in regression of TR and symptomatic improvement. DISCUSSION: This case illustrates how ACF can mimic primary right-sided or valvular pathology. Elevated inferior vena cava saturation and abnormal drainage patterns are key diagnostic clues. Its rarity, extracardiac origin, and reversible hemodynamics after endovascular aortic repair highlight the importance of diagnostic vigilance and multimodal imaging. TAKE-HOME MESSAGE: In patients with unexplained right heart failure and severe tricuspid regurgitation, consider high-output states from systemic-to-venous shunts such as ACF, which may be treatable.

Source: JACC Case Reports

DOI: 10.1016/j.jaccas.2025.106503