Arteriovenous malformations (AVMs) are abnormal connections between arteries and veins, bypassing the capillary system, typically due to a failure in the differentiation process during embryonic development [1]. The size of AVMs increases as high-pressure blood flows directly from arteries to veins, following the path of least resistance [2]. This report presents a rare and remarkable case of a 45-year-old man with a massive, intramuscular AVM in his back. Despite the challenges posed by its size, volume, and potential risk to the thoracic cavity, the AVM was successfully treated with surgical excision alone. This intervention dramatically improved the patient's quality of life.