Gastrocnemius venous aneurysm—a diagnostic dilemma

Symptomatic Gastrocnemius Vein Aneurysm

“…While only very few may become symptomatic, symptoms are not predictable across cases. One report found that pain worsened with lying down, owing to vein relaxation and bulging in the supine state, while muscle compression with standing improved symptoms and compressed the aneurysm [5]. However, our report found that the patient was symptomatic with standing, but the pain was relieved with rest.…”

“…Gastrocnemius vein aneurysms are extremely rare but as they have been found incidentally on imaging, their true prevalence may be underestimated [3]. When comparing the presented case with similar cases, all were found on imaging, and all were surgically excised with good long-term results [3][4][5]. Compression was not helpful in relieving symptoms.…”

“…Despite the positive outcomes following treatment, patients frequently have weeks to months of pain prior to diagnosis which may be debilitating, interrupt sleep, and interfere with activities of daily living [4][5]. Including the current case, patients have been initially diagnosed with venous insufficiency and reflux, and ultimately saw multiple practitioners before they were able to be treated, causing increased patient morbidity and increased healthcare cost [5]. Thus, we recommend imaging and specifically bedside venous duplex ultrasound in the setting of venous reflux as a rapid and cost-effective means of ruling out this diagnosis.…”

“…Primary venous aneurysms may be caused by inherent vessel wall weakness or have no known cause, while secondary venous aneurysms are caused by inflammation or mechanical stress [3]. However, gastrocnemius vein aneurysms are extremely rare; only three have been reported in the literature [3][4][5]. One followed compressive knee trauma, one presented with worsening pain when lying down, and the third presented with thrombosis.…”