Gastrocnemius venous aneurysm-a diagnostic dilemma
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Updated: Sep 3, 2025

Point-Of-Care Ultrasound Screening for Proximal Lower Extremity Deep Venous Thrombosis
Published on: February 10, 2023
Akiko Tanaka1, Taha Syed Zaidi1, S Keisin Wang1
1Department of Cardiothoracic and Vascular Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, TX.
Abstract:
A 63-year-old man with multiple previous orthopedic procedures in both lower extremities had presented to us for a third opinion regarding the point-specific pain in his right lateral calf. The initial diagnosis had been venous reflux at two other institutions. However, repeat imaging studies demonstrated an aneurysmal gastrocnemius vein without any other abnormalities, such as venous reflux or thrombosis. The patient had received compression stocking therapy for 6 months but had continued to experience increasing pain at night, especially when lying in bed. The patient was reexamined in the supine position, which showed a prominent bulge in the lateral calf. The bulge disappeared while he was in the upright position. The findings from a bedside ultrasound study confirmed that the gastrocnemius vein bulged out when the muscles were relaxed in the supine position and that the muscles compressed the vein in the standing position, squeezing the aneurysm. Thus, the decision was made to proceed with surgical excision. At 7 months after surgery, the patient remained symptom free.
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