Pre-existing vertebrojugular fistula unmasked following an uncomplicated internal jugular vein cannulation and its management.

A vertebrojugular fistula (VJF) is a vascular malformation characterised by abnormal communication between the vertebral artery (VA) and the internal jugular vein (IJV). It can occur following neck trauma, iatrogenic injury or spontaneously in connective tissue disorders, and rarely, it can be congenital. A young adult man in his early 20s with aplastic anaemia was planned for allogeneic haematopoietic stem cell transplantation (Allo-HSCT) for which right IJV cannulation was planned. After a single attempt at straightforward IJV cannulation, high flow was observed through all lumens; an anomalous arteriovenous connection was suspected; therefore, the catheter was removed immediately. The left IJV was successfully cannulated and the patient underwent urgent Allo-HSCT because of limited curative treatment options. Two days later, he presented with neck pain and small neck swelling and was investigated and found to have a VJF, which required coil embolisation of the fistula and sacrifice of the right VA. This report highlights the importance of pre-cannulation ultrasound screening of major neck vessels to study the IJV anatomy and its relationship with other neck vessels, compressibility and flow characteristics of the IJV using Doppler ultrasound (colour, pulsed wave and spectral wave Doppler patterns) to rule out thrombus or an anomalous arteriovenous connection, especially in patients with a history of prior IJV cannulation.