Image Diagnosis: Classic External Jugular Vein Aneurysm



 

Uttam Thakur, MBBS, MS1; Ajay Savlania, MS, MCh1; Swapnesh Kumar Sahu, MBBS1; Abhinaya Reddy, MBBS, MS1

Perm J 2019;23:19.021 [Full Citation]

https://doi.org/10.7812/TPP/19.021
E-pub: 10/03/2019

CASE PRESENTATION

A 43-year-old man presented with 9 months of swelling over the left lateral aspect of the neck, which had progressively increased in size (Figure 1) and was associated with mild, intermittent discomfort. On physical examination, there was a 5-cm x 6-cm oval, nonpulsatile, compressible area of swelling in the left posterior triangle of the neck, which increased in size on straining, coughing, and Valsalva maneuver. There was no bruit or venous hum on auscultation. Results of ultrasonography of the neck revealed an outpouching (aneurysm) of 54 mm x 24 mm from the left external jugular vein (EJV). Results of computerized tomographic venography showed a left EJV aneurysm (56 x 27 x 46 mm) (Figure 2) along the lateral aspect of the neck, with dependent layering thrombus within the aneurysm. The patient wanted treatment because of the increase in size and mild discomfort associated with it. Under local anesthesia, ligation of the proximal and distal EJV was performed, and the aneurysm was excised. The postoperative period was uneventful, and the patient was discharged on the same day. He was asymptomatic, with no swelling in the neck at 3-month follow-up. Postoperative ultrasonography assessment confirmed no residual or recurrent venous aneurysm.

19.021

Discussion

A jugular venous aneurysm most commonly involves the internal jugular vein, followed by the external and anterior jugular veins.1 It can be congenital, usually presenting by childhood with most commonly a fusiform configuration on the right side. A jugular venous saccular aneurysm can occur spontaneously too, and it also can occur rarely because of inflammation, trauma, and secondary to tumors. Venous aneurysms in adults are mostly acquired and they occur more commonly on the left side (attributed to compression of the left innominate vein by an atherosclerotic aorta).2,3 Saccular aneurysm of the EJV mostly presents as painless swelling in the neck, although thrombosis of an aneurysm can present with painful swelling and symptoms secondary to mass effect on the adjacent structures. According to Mohanty et al,4 “The presence of unilateral, nontender, soft, reducible, and non-pulsatile swelling that enlarges with straining, sneezing, or Valsalva maneuver is a characteristic of venous aneurysm.”

Ultrasonography can provide information regarding the solid or cystic nature of lesions, differentiate vascular lesions from nonvascular lesions, and identify the site of origin, but a computed tomography scan or magnetic resonance venogram may be necessary to know the exact extent and relationship to adjacent structures if treatment is planned.5

Asymptomatic aneurysms can be managed expectantly with regular follow-up, as no significant complication (rupture, mass effect) is associated with them. Surgical excision is considered mostly for cosmetic reasons or for a painful thrombosed aneurysm.6 An EJV saccular or fusiform aneurysm can be safely managed by ligation and excision. We managed our index patient with simple ligation at both ends of the EJV with excision of the aneurysm, and the patient was doing well at 3-month follow-up.

Disclosure Statement

The author(s) have no conflicts of interest to disclose.

How to Cite this Article

Thakur U, Savlania A, Sahu SK, Reddy A. Image diagnosis: Classic external jugular vein aneurysm. Perm J 2019;23:19.021. DOI: https://doi.org/10.7812/TPP/19.021

Author Affiliations

1 Department of General Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India

Corresponding Author

Ajay Savlania, MS, MCh (drajaysaviania@gmail.com)

References
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 3. Nwako FA, Agugua NE, Udeh CA, Osuorji RI. Jugular phlebectasia. J Pediatr Surg 1989 Mar;24(3):303-5. DOI: https://doi.org/10.1016/s0022-3468(89)80019-3.
 4. Mohanty D, Jain BK, Garg PK, Tandon A. External jugular venous aneurysm: A clinical curiosity. J Nat Sci Biol Med 2013 Jan-Jun;4(1):223-5. DOI: https://doi.org/10.4103/0976-9668.107296.
 5. 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 Feb;35(2):94-6. DOI: https://doi.org/10.1002/jcu.20263.
 6. Ascher E, Salles-Cunha S, Hingorani A. Morbidity and mortality associated with internal jugular vein thromboses. Vasc Endovascular Surg 2005 Jul-Aug;39(4):335-9. DOI: https://doi.org/10.1177/153857440503900405.

Keywords: external jugular vein aneurysm, external jugular vein, internal jugular vein, ultrasonography

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