Volume 50, Issue 3 Fall 2026 JVU 503-ee | 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 stationary (standing) arterial waves—regular, symmetric undulations of the arterial wall—before the findings were confirmed by angiographic imaging. The observations challenge the view that these waves are artifacts limited to contrast-enhanced imaging and suggest they may represent a genuine vascular phenomenon.<br /><br />The first patient, a 32-year-old woman with recurrent cold-related toe swelling and discoloration, had normal ankle perfusion but reduced toe perfusion. Ultrasound showed undulations in several arteries of both lower legs without elevated velocities or disturbed flow. Similar changes were seen on magnetic resonance angiography a month later. Her symptoms were considered consistent with Raynaud’s phenomenon.<br /><br />The second patient, a 32-year-old man evaluated after a gunshot wound, had symmetric arterial wall undulations in several segments of both legs. Ultrasound showed no associated flow disturbance, and repeat CT angiography two days later confirmed a similar pattern. He was managed conservatively.<br /><br />The findings were reproducible across different ultrasound systems and persisted on subsequent imaging. The authors suggest that reflected blood-flow waves interacting with forward-moving waves—potentially due to increased distal resistance—could produce the pattern, although its underlying mechanism and clinical importance remain uncertain.<br /><br />A key diagnostic consideration is distinguishing standing waves from fibromuscular dysplasia (FMD). Unlike FMD, which can cause turbulence and elevated velocities, the waves in these cases were not associated with abnormal flow. Recognizing this distinction may prevent misdiagnosis. Further research is needed to clarify the phenomenon’s causes, persistence, and significance.

Keywords

duplex ultrasound

standing arterial waves

arterial wall undulations

angiographic imaging

Raynaud phenomenon

lower extremity arteries

fibromuscular dysplasia

CT angiography

magnetic resonance angiography

vascular phenomenon