Pulsatile popliteal veins

Elderly patient with history of:

Bilateral pedal edema 

Discoloration of legs bilaterally 

Old fracture femur left side treated surgically 

Inability to fully extend knees. This made it difficult to get a long section of the popliteal veins. 

Ultrasound and color Doppler imaging of the deep veins was done:

Ultrasound imaging findings:

Markedly pulsatile popliteal veins bilaterally 

The common femoral and femoral veins show normal flow patterns. 

Explanation of the findings:

The edema of the lower limbs can explain the pulsatility of the popliteal veins. When there is edema, the pressure in the veins increases. This can cause the veins to dilate and become more visible. In addition, the increased pressure can also cause the veins to pulsate.

The femoral veins are larger than the popliteal veins, so they are less likely to pulsate. However, if there is enough edema, the femoral veins can also become dilated and pulsatile.

In the case of this elderly patient, the pulsatile popliteal veins are likely due to the edema in his lower limbs. The edema is probably caused by a combination of factors, such as poor circulation, varicose veins, and inactivity.

Management:

The doctor may recommend compression stockings, medication, or surgery to improve the circulation in the legs.

Other causes:

Here are some other possible causes of pulsatile popliteal veins:

Deep vein thrombosis (DVT): no obvious DVT seen. So not likely. 

Popliteal artery aneurysm: not likely 

Popliteal pseudoaneurysm: less likely 

Venous malformation: possible 

Arteriovenous fistula: the popliteal AV fistula could be the result of trauma, of which the patient had some years ago or due to surgery. 

CCF: right heart failure may explain the pedal edema. Further investigations are advised. This can explain the bilateral popliteal veins being pulsatile being the result of the edema of the edema. 

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Vascular Doppler ultrasound imaging