An AVF is an abnormal connection between an artery and a vein, causing the blood flow to bypass the capillaries and tissues below it. A large untreated AVF may cause massive shunt flow, leading to serious complications, such as congestive heart failure and venous hypertension. Timely identification and treatment of an AVF can dramatically improve the patients’ hemodynamics as well as symptoms. CT imaging plays an important and valuable role in the evaluation of an AVF. It is also widely accepted by the patients, since it is non-invasive. In this case, an AVF between the RIIA and the RIIV causing a significant dilation of the IVC and right heart failure, is critical and very rare. The scan and contrast injection protocols are modified to successfully catch the opacity of the IVC in the arterial phase. The optimal image quality and automated workflow granted by dual source CT (DSCT) support the physicians in reaching a quick and confident diagnosis, as well as effective treatment planning. Advanced techniques, such as cinematic volume rendering technique (cVRT), enable a lifelike, three-dimensional demonstration of the anatomical details facilitating an easy and straightforward communication.