Unusual Causes of Varicose Veins in the Lower Extremities: CT Venographic and Doppler US Findings

Seung Chaijung, MD, What Lee, MD , Jin Wook Chung, MD , Hwan Jun Jae, MD , Eun-Ah Park, MD , Kwang Nam Jin, MD , Cheong-Il Shin, MD , Jae Hyung Park, MD

There are various causes of varicose veins in the lower extremities. Among the causes are venous insufficiency of the saphenofemoral junc­tion, saphenopopliteal junction, or usual perforating veins. Traditionally, Doppler ultrasonography (US) has been used for evaluation of varicose veins. Sometimes, varicose veins arise from an unexpected anatomic source; in these cases, computed tomographic (CT) venography can provide an overview of the varicose veins. Doppler US with comple­mentary CT venography is useful for determining the precise cause of varicose veins. Between November 2003 and March 2008, the au­thors evaluated 1350 cases of varicose veins in the lower extremities with both CT venography and Doppler US. The varicose veins were classified according to their causes; unusual causes were studied and included vulvoperineal varicosity, intraosseous perforating vein incom­petence, round ligament varicosity, persistent sciatic vein incompetence, Klippel-Trenaunay syndrome, and portosystemic collateral pathways. Radiologists should be familiar with the complete range of primary causes of varicose veins in the lower extremities and with their radio­logic manifestations and should recognize the complementary role of CT venography in their evaluation.