Internal jugular venous aneurysm

Abstract

A61-year-oldwomanwas referred to the vascular surgery departmentwith a 4-month history of amass on the right side of her neck (A). Themass was first noted shortly after extraction of a right lower tooth. The mass was tender but not associated with any erythema or systemic signs of sepsis; nevertheless, she was treated by her local physician with oral antibiotics. There was no reported history of trauma. There was no airway or swallowing compromise. Her past medical history included ischemic heart disease and treated hypertension. On examination, she had a 5 4-cmmass on the right side of the neckwhen sitting upright. There was no increase in size with theValsalvamaneuver; themass was difficult to empty, although there was some reduction in the size of the mass in the recumbent position. There was no bruit heard on auscultation. A duplex ultrasound examination revealed a large right internal jugular vein aneurysm, 4.3 2.6 cm in diameter, with a low-flow “pseudothrombosis” appearance (B) and a “valve-like” effect preventing emptying because of the redundant nature of the sac. The left internal jugular vein was also aneurysmal, measuring 2.3 1.5 cm. Findings on hematologic investigations were normal, with no elevation in inflammatory markers. Computed tomography venography confirmed the diagnosis and ruled out gross mediastinal disease (Cover). Diagnostic venography revealed a small atrial septal defect, and there was no differential venous pressure in the jugular system (C). Echocardiography was normal with an ejection fraction of 65%. The treatment options were discussed with the patient, and she elected conservative management as the mass was asymptomatic except for its cosmetic appearance, and she is being observed with annual clinical review. There has been no change to the mass at 30 months of follow-up. The history of dental extraction was probably incidental to the patient’s presentation. The patient consented for presentation and publication of her rare condition. Jugular venous aneurysms are rare, usually congenital, and more often reported in the pediatric literature. Although rare, they usually have a benign course, andmostpatientspresentwithanasymptomaticneckmass.Treatmentoptions include surgical resectionwith lateral venorrhaphy andconservativemanagement.Treatment is offered for symptomatic aneurysms and for cosmetic reasons.