|Year : 2021 | Volume
| Issue : 1 | Page : 99-101
External jugular vein aneurysm as a rare cause of neck swelling
Loveleen Garg1, Savjot Singh Narang1, Ashvind Bawa1, Tushar Patial2
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 Submission||21-Apr-2020|
|Date of Acceptance||05-May-2020|
|Date of Web Publication||20-Feb-2021|
Department of Plastic and Reconstructive Surgery, Dayanand Medical College and Hospital, Ludhiana, Punjab
Source of Support: None, Conflict of Interest: None
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
| Introduction|| |
Venous aneurysms were first described by Harris in 1928. Venous aneurysms have been reported in several anatomical locations in the neck, with the most common site being the internal jugular vein., 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. 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., Hereby, we report a case of an EJV aneurysm (EJVA) presented as neck swelling that was surgically resected.
| Case Report|| |
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.
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|
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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)|
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|Figure 4: Postoperative image after resection (external jugular vein: green arrow)|
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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|| |
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. Abbott and Leigh, in categorizing aneurysmal venous disease, stated that saccular lesions can be classified as true venous aneurysms. Saccular aneurysms have degenerative histology with an increased tendency for thrombosis and are often reported in adults involving the EJV and anterior jugular vein., 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. 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.
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. 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. 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.
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., 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|| |
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.
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Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4]