Great Saphenous Vein Pseudoaneurysm: A Rare Case Report

Great saphenous vein (GSV) pseudoaneurysm represents a rare but clinically significant vascular anomaly, characterized by a localized disruption of the venous wall. A 35-year-old female presented with bilateral lower limb pain and pedal edema with a history of local trauma was referred to the department of radiodiagnosis for Doppler evaluation of suspected varicose veins. B-mode ultrasound demonstrated a dilated right great saphenous with an ovoid anechoic outpouching communicating with the GSV, demonstrating reduced size in supine position and increased size with gradual filling with blood and yin–yang sign on color Doppler on standing. Based on the ultrasound findings and clinical history, a diagnosis of posttraumatic GSV pseudoaneurysm was given. GSV pseudoaneurysm poses diagnostic challenges. Etiologies include iatrogenic injury, most commonly following flush saphenofemoral ligation and vein stripping, and noniatrogenic factors such as blunt trauma. Patients typically present with a soft, nonpulsatile, posture-dependent mass that can mimic hernia, soft tissue tumor, or lymphadenopathy, often delaying diagnosis. Duplex ultrasound remains the diagnostic gold standard, revealing swirling flow and venous communication; magnetic resonance imaging and computed tomography offer adjunctive value. Management ranges from observation for asymptomatic cases to surgical excision for symptomatic or enlarging lesions. Early diagnosis prevents thrombosis or embolization. Increased awareness is the key to standardizing management.