Presentation
Swollen left upper limb. Currently on dialysis for end stage renal disease with a left arm arteriovenous fistula. To assess for thrombosis.
Patient Data
At the anastomosis/fistulation point of the left proximal anterior elbow, of the brachial artery and the cephalic vein, color Doppler mapping reveals speckled/mixed signals of color hues ranging from deep blue, to sky blue, to orange, to yellow consistent with color bruit artifacts primarily attributed to both the arterial and the venous intra-luminal flows.
Pulsed Doppler assessment of the fistula point exhibits turbulence and pulsatile venous flow downstream from the arteriovenous (AV) connection (expected). No aneurysmal change, peri-fistula collections or thrombosis.
There is subcutaneous tissue edema of the left upper limb with echogenic fat pads interspersed with hypoechoic linear fluid spaces akin to a labyrinthine pattern appearance.
Case Discussion
Sonographic pictorial illustration of color bruit artifact at an arteriovenous fistula point (proximal to the anterior elbow joint) of the deep brachial artery and the cephalic vein, which is an expected finding.
Such bruit artifacts, are motion artifacts in which motion is generated within an organ rather than involving an entire organ and is seen as a color mosaic (not a single homogeneous color) associated with turbulence caused by vascular tissue vibration. The artifact is the imaging analog of an auditory bruit or palpable thrill1-3.
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