Ultrasound imaging findings of varicose veins from tibial bone perforator in three cases

Abstract

In varicose veins in the lower extremities, the veins dilate due to venous valve dysfunction and are generally saphenous or the lateral branch type. We report three very rare cases of varicose veins originating from a tibial perforator. The first case is a woman in her 60s. She visited our hospital with a varicose vein (C1) in her left lower extremity. The second case is a man in his 50s. He visited our hospital with bilateral lower limb edema and bilateral varicose veins (C4a). The third case is a man in his 60s. He visited our hospital with left lower extremity edema and venous dilatation (C4a). Ultrasonography revealed a small hole on the anterior surface of the tibia on the affected side, which was common to all three cases, and a dilated blood vessel covering the small hole was depicted. On color flow imaging using milking and on pulse Doppler, venous blood flow from the inside of the tibia to the outside of the bone through a small hole was observed. The diagnosis was varicose veins of the lower extremities derived from a perforator of the tibia. For varicose veins derived from an incompetent tibial perforator, ultrasonography was the only examination that could identify the causative vein.