Volume 50, Issue 3 Fall 2026 JVU 503-aa | Detection of Stationary Waves on Duplex Ultrasound: Two Case Reports-Detection of Stationary Waves on Duplex Ultrasound: Two Case Reports

Detection of Stationary Waves on Duplex Ultrasound: Two Case Reports

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This case report describes two patients in whom duplex ultrasound detected rare stationary (standing) arterial waves—regular, symmetric undulations of the arterial wall—later confirmed by angiographic imaging.<br /><br />The first patient, a 32-year-old woman with cold-sensitive, recurrently swollen and discolored toes, had normal ankle perfusion but reduced toe perfusion. Ultrasound showed undulations in bilateral tibial and peroneal arteries without elevated velocities or disturbed flow. Magnetic resonance angiography one month later showed similar findings. Her symptoms were considered most consistent with Raynaud’s phenomenon, and she was treated medically.<br /><br />The second patient, a 32-year-old man evaluated after a gunshot wound, had no identified arterial injury. Ultrasound showed similar undulations in several segments of both legs, again without abnormal flow or velocity. A repeat CT angiogram two days later confirmed the pattern.<br /><br />The authors suggest that these findings may represent a genuine physiological wall-motion phenomenon rather than an artifact limited to angiographic imaging. Their presence on different ultrasound systems and persistence across modalities support this possibility. A proposed mechanism is that increased resistance downstream—such as vasospasm or external compression—reflects arterial pulse waves, producing standing waves.<br /><br />The authors emphasize distinguishing these undulations from fibromuscular dysplasia, which typically causes flow disturbance and increased velocities. The clinical significance and underlying mechanism of standing arterial waves remain uncertain, and further research is needed to establish their reproducibility and implications.

Keywords

duplex ultrasound

standing arterial waves

arterial undulations

Raynaud phenomenon

tibial arteries

peroneal arteries

angiographic imaging

magnetic resonance angiography

CT angiogram

fibromuscular dysplasia