An unusual cause of heart failure.

Pelvic arteriovenous malformations (AVMs) are uncommon entities that can present with symptoms resulting from compression of adjacent structures, ischemia due to 'steal phenomenon' or, rarely, heart failure. We present a case of heart failure in a patient who presented to our facilities for heart transplant and a prior diagnosis of idiopathic dilated cardiomyopathy; further evaluation revealed a massive pelvic AVM as causative for the heart failure. This case emphasizes the importance of a thorough physical examination to guide appropriate diagnostic testing.