Volume 50, Issue 2 Summer 2026 JVU 502-88 | Reverberation Artifacts in the Area of the Superficial Femoral Artery-Reverberation Artifacts

Reverberation Artifacts

Pdf Summary

This case report describes a 59-year-old asymptomatic man who returned for routine duplex ultrasound follow-up six months after treatment of an embolic occlusion of the left superficial femoral artery (SFA) and popliteal artery. His prior treatment included thrombectomy, thrombolysis, drug-coated balloon angioplasty, and stent placement. On follow-up ultrasound, a bright linear structure was seen crossing the SFA lumen and appeared to extend into the stent, raising concern for an arterial dissection. A moderate stenosis was also noted just before the stent.<br /><br />Further evaluation showed that the apparent dissection was not real. B-flow imaging demonstrated that the “membrane” did not match the actual border between perfused and nonperfused lumen. Similar linear findings were seen on the right, untreated SFA, where no stenosis or true pathology existed. Review of the angiogram and the imaging pattern led the authors to conclude that the finding represented a reverberation artifact caused by the fascia, not a dissection flap. The left-sided stenosis was attributed to residual wall-adherent thrombus after prior thrombolytic therapy.<br /><br />The article explains that reverberation artifacts occur when ultrasound waves bounce repeatedly between reflective interfaces and may create duplicate or misleading structures. In vascular imaging, these artifacts can mimic dissection and potentially lead to misdiagnosis or unnecessary intervention. The authors emphasize that recognizing artifacts requires good image quality, awareness of technical and patient-related factors, and use of complementary tools such as color duplex and B-flow imaging. Careful comparison of vessel segments and scanning from multiple angles are also important.<br /><br />The main conclusion is that clinicians performing lower-extremity arterial ultrasound should be alert to reverberation artifacts to avoid false diagnosis of dissection and prevent unnecessary procedures.

Keywords

reverberation artifact

arterial ultrasound

superficial femoral artery

popliteal artery

arterial dissection

duplex ultrasound

B-flow imaging

stent placement

vascular imaging

thrombolysis