The outlet duct is the only outlet flow component of the pump as turbines (PATs). The flow state within it not only affects its operation stability but also influences the safe operation of downstream process equipment. The undesirable flow phenomenon of the vortex is the main reason for pressure pulsations and vibrations; therefore, it is important to adopt simulation and experimental methods to reveal the vortex-pressure fluctuation interaction characteristics in the outlet duct of PATs. Firstly, the spatial and temporal evolution of the vortex in the outlet duct under different operation conditions were compared based on the Q-vortex identification criterion. Subsequently, the frequency components corresponding to local high amplitude vorticity and pressure pulsations were clarified. Finally, the relationship between vortex evolution and the pressure pulsations in the outlet duct was established. The results showed that the flow rates of the turbine significantly affected the spatial and temporal evolution of the vortex rope in the outlet duct. The front chamber leakage flow and vortex shedding from the blade trailing edge also influenced the vortex distribution characteristics in the outlet duct. The dominant frequency of the pressure pulsation in the outlet duct was 6 fn under different operating conditions, and the amplitude of the pressure pulsation increased with the flow rates. The effect of vortex evolution on the local pressure pulsation characteristics decreased with increasing flow rates. The results can be used to improve and stabilize the operation and further optimization of PATs.