Iliac arteriovenous fistula with renal insufficiency, ascites, hepatomegaly, and abnormal liver test results

Arteriovenous fistula presents rarely with liver involvement. A 73-year-old man had new-onset ascites, hepatomegaly, and abnormal liver and renal func tion test results. An abdominal computed tomogram revealed a 7.6-cm interna l iliac aneurysm but no other abnormality to account for his ascites, An ao rtogram demonstrated a 1.5-cm internal iliac arteriovenous fistula that sub sequently was repaired, leading to resolution of his symptoms and laborator y abnormalities. High-output cardiac failure should be considered in the di fferential diagnosis of patients with new-onset massive ascites, hepatomega ly, and liver test abnormalities.