External jugular vein aneurysm: a rare cause of fluctuating neck swelling

Excerpt

A 36-year-old previously healthy woman presented to the otorhinolaryngology clinic with a painless progressive swelling on the right side of the neck for 4 months which become prominent while coughing. She denied any history of dysphagia, voice change, or facial congestion. There was no history of preceding cervical trauma or venepuncture at that site. General examination was unremarkable. Physical examination revealed an ill-defined, soft, non-tender, non-pulsatile and compressible swelling at the lateral border of lower one-third of right sternocleidomastoid muscle which increased to a size of 3 × 3 cm on performing Valsalva manoeuvre (Fig. 1a). The skin over the swelling was intact and showed no evidence of inflammation and there was no bruit on auscultation. Fiberoptic laryngoscopy examination showed normal larynx and hypopharynx. Routine blood tests were within the normal range including coagulation studies. The chest X-ray ruled out any mediastinal mass. An ultrasound scan revealed a 30 × 25 mm homogenous, saccular, compressible structure which on colour Doppler identified communication between the lesion and external jugular vein (EJV) (Fig. 1b). Computed tomography (CT) angiography showed the presence of a homogeneously enhancing lesion which was communicating with the lower part of the EJV thereby confirming the saccular venous aneurysm of right EJV probably idiopathic in origin (Fig. 1c). The patient was given the option for surveillance or watchful observation of the swelling because of its benign nature, however, she had opted for surgery due to its disfiguring appearance. The patient underwent surgical excision under local anaesthesia through a supraclavicular transverse skin crease incision two finger-breadths above the clavicle. A 30 × 25 mm saccular aneurysm was noted arising from an external jugular vein which was excised after ligating proximal and distal ends of EJV with minimal manipulation of the aneurysm to avoid possible rupture and a chance of embolism (Fig. 1d). Pathologic study confirmed the diagnosis of external jugular vein aneurysm (Fig. 1e). She had an uneventful postoperative period and remained symptom-free at 2-year follow up.

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