A 38-year-old man presented with a pulsatile cervical mass and tinnitus for 10 months. His symptoms had begun after he received a blunt trauma on the left neck. An axial computed tomography angiography of the neck (A) demonstrated an abnormal communication between the vertebral artery and the markedly dilated internal jugular vein on the left neck. An engorged epidural vein on the left ventral aspect of the spinal canal was also identified. Volume rendering (Cover) and coronal maximum-intensity projection images (B) showed an abnormal dilated vascular space adjacent to the left vertebral artery at the C1-2 level. Right vertebral angiography (C) demonstrated an abnormal vascular connection between the left extracranial vertebral artery and the epidural venous plexus and the internal jugular vein. A steal phenomenon to the fistula was clearly shown. Left vertebral angiography (D) revealed a high-flow arteriovenous fistula (AVF) at the C1-2 junction. A laterally directed fistulous hole drained into the epidural vein and internal jugular venous channel. A detachable coil was positioned in the fistula site. The patient recovered uneventfully.