The complex three-dimensional unsteady flow developing in the draft tube of a Francis turbine is responsible for pressure fluctuations, which could prevent the whole hydropower plant from operating safely. Indeed, the Francis draft tube is subjected to inlet swirling flow, divergent cross section, and the change of flow direction. As a result, in low discharge off-design operating conditions, a cavitation helical vortex, so-called the vortex rope develops in the draft tube and induces pressure fluctuations in the range of 0.2–0.4 times the runner frequency. This paper presents the extensive unsteady wall pressure measurements performed in the elbow draft tube of a high specific speed Francis turbine scale model at low discharge and at usual plant value of the Thoma cavitation number. The investigation is undertaken for operating conditions corresponding to low discharge, i.e., 0.65–0.85 times the design discharge, which exhibits pressure fluctuations at surprisingly high frequency value, between 2 and 4 times the runner rotation frequency. The pressure fluctuation measurements performed with 104 pressure transducers distributed on the draft tube wall, make apparent in the whole draft tube a fundamental frequency value at 2.5 times the runner frequency. Moreover, the modulations between this frequency with the vortex rope precession frequency are pointed out. The phase shift analysis performed for 2.5 times the runner frequency enables the identification of a pressure wave propagation phenomenon and indicates the location of the corresponding pressure fluctuation excitation source in the elbow; hydroacoustic waves propagate from this source both upstream and downstream the draft tube.