39 years old ex-soldier, hod shrapnel wounds of the left popliteal region and right buttock lo years ago, with the complaints of gradually increasing edematous swelling of the leg and a sensation of heaviness in the left leg in the course of the last 3 years, was admitted to the Seoul Naval Hospital.
At the time of his admission he had a generalized swelling of the left leg, with a 3 cm greater circumference than the intact leg, and a child´s fist sized tumor in the left popliteal region, with a scar over it. A remarkable thrill was felt over the above mentioned tumor as well as in the left inguinal region which gave the suspicion of 2 arterio-venous fistulae. The surgery was decided upon for the popliteal tumor mass.
On completion of the surgery in which a 7 cm X 4 cm sized varicous vein and a lcmX 1.5 cm sized arterio-venous fistule were removed, all the undesirable symptoms and signs disappeared and it was amazing that even the thrill felt over the inguinal region had disappeared.
Since we read, in the current medical literature, that thrills caused by arterio-venous fistulae are felt only over the sites where those fistules exist, we face the question "what caused the thrill felt over the patient´s left inguinal region". Finally, considering the case presented, we believe that the thrill felt over the patient´s inguinal region was a transmitted one from the popliteal fistula. And we also feel that the stronger the competency of the venous valves distal to the arterio-venous fistula the better is the transmission of the thrill in the proximal direction.
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