We report a case of arteriovenous fistula due to spontaneous rupture o
f an aortic aneurysm into the inferior vena cava. This is a rare compl
ication of atheromatous aneurysm, often difficult to diagnose as the c
linical presentation may be obscure. Although aortography is the refer
ence diagnostic investigation, spiral CT aquisition with 3D and 2D ref
ormation allowed visualization of the arteriovenous communication and
provided an accurate diagnosis.