Table of Contents  
CASE REPORT
Year : 2021  |  Volume : 8  |  Issue : 1  |  Page : 99-101

External jugular vein aneurysm as a rare cause of neck swelling


1 Department of Surgery, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
2 Department of Plastic and Reconstructive Surgery, Dayanand Medical College and Hospital, Ludhiana, Punjab, India

Date of Submission21-Apr-2020
Date of Acceptance05-May-2020
Date of Web Publication20-Feb-2021

Correspondence Address:
Tushar Patial
Department of Plastic and Reconstructive Surgery, Dayanand Medical College and Hospital, Ludhiana, Punjab
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijves.ijves_40_20

Rights and Permissions
  Abstract 


Venous aneurysms of the external jugular veins are rare. In this case report, we describe the case of a 49-year-old gentleman who presented to us with a painless neck swelling and underwent surgical resection.

Keywords: Aneurysm, thrombosis, vein


How to cite this article:
Garg L, Narang SS, Bawa A, Patial T. External jugular vein aneurysm as a rare cause of neck swelling. Indian J Vasc Endovasc Surg 2021;8:99-101

How to cite this URL:
Garg L, Narang SS, Bawa A, Patial T. External jugular vein aneurysm as a rare cause of neck swelling. Indian J Vasc Endovasc Surg [serial online] 2021 [cited 2021 Feb 25];8:99-101. Available from: https://www.indjvascsurg.org/text.asp?2021/8/1/99/309711




  Introduction Top


Venous aneurysms were first described by Harris in 1928.[1] Venous aneurysms have been reported in several anatomical locations in the neck, with the most common site being the internal jugular vein.[2],[3] Although fusiform venous dilatations represent a frequent occurrence, saccular venous aneurysms of the external jugular veins (EJVs) are extremely rare and are typically seen in adulthood, secondary to trauma or diseases involving veins.[4] Jugular venous aneurysm generally presents as a soft, compressible, painless neck swelling that increases on straining or the Valsalva maneuver and needs to be differentiated from other cystic neck swellings that appear or increase on straining. Imaging modalities such as ultrasound with color Doppler, computed tomography, or magnetic resonance imaging can be used to confirm the diagnosis.[5],[6] Hereby, we report a case of an EJV aneurysm (EJVA) presented as neck swelling that was surgically resected.


  Case Report Top


A 49-year-old male presented to the surgical outpatient department with complaints of painless swelling over the right side of the neck for 2 years, which was insidious in onset and gradually increased over time. The patient had no history of trauma to the neck region. There was no significant past medical or surgical illness for which the patient required hospitalization. On examination, there was a soft, compressible, nontender, and nonpulsatile swelling on the right side of the neck measuring approximately 2 cm × 2 cm just behind the posterior border of the sternocleidomastoid muscle and was not moving with deglutition [Figure 1]. The swelling was more prominent on Valsalva maneuver. No bruit was audible on auscultation.
Figure 1: The swelling on the right side of the neck

Click here to view


Ultrasonography of the neck with color Doppler revealed a well-defined cystic lesion in the right lateral part of the neck measuring 2 cm × 1.4 cm with slow flow within the lesion, suggestive of a venous aneurysm possibly arising from one of the branches of the EJV [Figure 2]. The patient was diagnosed as a case of venous aneurysm likely arising from the EJV, and he was planned for surgery.
Figure 2: Ultrasound neck revealing well-defined cystic lesion with slow flow on color Doppler, suggestive of venous aneurysm

Click here to view


After preanesthetic checkup, the patient was taken for surgery. Intraoperatively, there was a 2 cm × 2 cm saccular aneurysm arising from the EJV [Figure 3], and excision of the aneurysm was done [Figure 4]. The patient was shifted to the surgical recovery room postoperatively and kept under observation for the next 24 h.
Figure 3: Intraoperative image showing aneurysm (blue arrow) arising from the external jugular vein (black arrow)

Click here to view
Figure 4: Postoperative image after resection (external jugular vein: green arrow)

Click here to view


Postoperatively, the patient recovered well and was discharged after 3 days of admission. On follow-up at 3 months, the patient was doing well with routine activities, and there was no recurrent swelling.


  Discussion Top


In a study by Gillespie et al., 77% of venous aneurysms were located in the lower extremities, 10% in the upper extremities, and 13% involved the internal jugular vein.[7] Abbott and Leigh, in categorizing aneurysmal venous disease, stated that saccular lesions can be classified as true venous aneurysms.[8] Saccular aneurysms have degenerative histology with an increased tendency for thrombosis and are often reported in adults involving the EJV and anterior jugular vein.[4],[9] Jugular venous aneurysm or jugular phlebectasia is the most common venous malformation involving the neck veins and involves the internal jugular vein, EJV, and anterior jugular vein, in descending order of occurrence.[10] Macroscopic fusiform dilatation or phlebectasia in the neck veins is considered to be congenital in origin. However, saccular dilatation or aneurysm involving the jugular venous system can appear either spontaneously, in the absence of any known etiologic cause, or secondary to tumors, inflammation, and trauma.[11]

Clinically, the preoperative diagnosis can be accurately established. Saccular aneurysm of the jugular vein mostly presents as a painless swelling. However, thrombosis within the aneurysm can produce pain in the swelling. The differential diagnosis of lateral cervical masses includes arteriovenous malformation, thyroglossal cysts, retention cysts, cystic hygroma, pharyngocele, laryngocele, different tumors, and cupula inflation.[9] The presence of a unilateral, nontender, soft, and nonpulsatile swelling that enlarges with straining or Valsalva maneuver, superficial to the right sternomastoid muscle in the course of EJV, is the characteristic feature of a venous aneurysm. These findings were confirmed in our case on examination, and the patient was diagnosed as a case of venous aneurysm.

The radiological investigations for diagnosis range from simple ultrasonography to sophisticated tools such as venography, computed tomography angiography, and magnetic resonance angiography. However, ultrasound with Doppler imaging has replaced other costly diagnostic tools and gold standard investigation for EJVA.[12] Ultrasound with Doppler allows differentiation between cystic and solid lesions and vascular and nonvascular lesions and identifies the site of origin of the lesion and its relationship with the surrounding structures in the neck.[12]

For asymptomatic and uncomplicated jugular venous phlebectasia, conservative management with regular follow-up is recommended; surgery in the form of exclusion and bypass is advocated for symptomatic, enlarging, disfiguring, and complicated jugular venous phlebectasia. The recommendation for saccular jugular venous aneurysms is surgical excision.[9],[12] Surgical resection also eliminates the theoretical risk of aneurysmal rupture and pulmonary embolism. In our case, surgical excision of the venous aneurysm was done.


  Conclusion Top


EJVA is a very rare clinical condition. It can be easily diagnosed on ultrasonography with color Doppler, which remains the first investigation of choice to diagnose the condition. Surgical excision is safe and easy and allows for a definitive solution for this disorder.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Harris R. Congenital venous cyst of the mediastinum. Ann Surg 1928;88:953-6.  Back to cited text no. 1
    
2.
McCready RA, Bryant MA, Divelbiss JL, Chess BA. Subclavian venous aneurysm: Case report and review of the literature. J Vasc Surg 2007;45:1080-2.  Back to cited text no. 2
    
3.
Lee HY, Yoo SM, Song IS, Yu H, Lee JB. Sonographic diagnosis of a saccular aneurysm of the internal jugular vein. J Clin Ultrasound 2007;35:94-6.  Back to cited text no. 3
    
4.
Anzidei MS, Fraioli F, Catalano C. CT venography In: Saba L SJ, editor. Multi-Detector CT Imaging: Principles, Head, Neck, and Vascular Systems. 1st ed. FL: CRC Press; 2007.  Back to cited text no. 4
    
5.
Ilijevski NS, Radak S, Vucurevic G, Sagic D, Otasevic P, Tasic N, et al. Jugular vein aneurysm. Vascular 2008;16:291-4.  Back to cited text no. 5
    
6.
Fitoz S, Atasoy C, Yagmurlu A, Erden I, Akyar S. Gadolinium-enhanced three-dimensional MR angiography in jugular phlebectasia and aneurysm. Clin Imaging 2001;25:323-6.  Back to cited text no. 6
    
7.
Gillespie DL, Villavicencio JL, Gallagher C, Chang A, Hamelink JK, Fiala LA, et al. Presentation and management of venous aneurysms. J Vasc Surg 1997;26:845-52.  Back to cited text no. 7
    
8.
Abbott OA, Leigh TF. Aneurysmal dilatations of the superior vena caval system. Ann Surg 1964;159:858-72.  Back to cited text no. 8
    
9.
Hopsu E, Tarkkanen J, Vento SI, Pitkäranta A. Acquired jugular vein aneurysm. Int J Otolaryngol 2009.  Back to cited text no. 9
    
10.
LaMonte SJ, Walker EA, Moran WB. Internal jugular phlebectasia. A clinicoroentgenographic diagnosis. Arch Otolaryngol 1976;102:706-8.  Back to cited text no. 10
    
11.
Nwako FA, Agugua NE, Udeh CA, Osuorji RI. Jugular phlebectasia. J Pediatr Surg 1989;24:303-5.  Back to cited text no. 11
    
12.
Grigorescu I, Dumitrascu DL, Manole S, Fodor D. Pseudoaneurysm of the external jugular vein communicating with the internal jugular vein. Case report. Med Ultrason 2012;14:257-60.  Back to cited text no. 12
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

Top
 
 
  Search
 
Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

 
  In this article
   Abstract
  Introduction
  Case Report
  Discussion
  Conclusion
   References
   Article Figures

 Article Access Statistics
    Viewed44    
    Printed0    
    Emailed0    
    PDF Downloaded6    
    Comments [Add]    

Recommend this journal


[TAG2]
[TAG3]
[TAG4]