External jugulary vein aneurysm: a rare cause if neck swelling

To the Editor: In contrast to aretrial aneurysms, true venous aneurysms are rarely encountered.¹ Aneurysmal dilatations in cervical veins are rare due to low pressure in the vena cava system.

A 4-year-old male was admitted to our clinic with a progressive swelling in the right side of the neck. The swelling was well demonstrated by the Valsalva manoeuvre. The swollen part had developed 2 months prior to admission to our clinic. The mass localized laterally to the right sternocleidomastoid muscle. Physical examination revealed a soft, round, mobile, non-pulsating mass approximately 5×4 cm in diameter. Other systems were normal. The differential diagnosis included a laryngocele, a superior mediastinum tumor or cyst and a venous aneurysm. Diagnosis was made using multi-slice computed tomography (MSCT). MSCT of the region of the abnormality revealed an external jugular vein aneurysm (Figure 1A, B). An operation was performed under general anesthesia. The aneurysm was freed from the neighboring tissues by separation with supraclavicular incision, and an aneurysmal dilatation was extracted. The postoperative course was uneventful. Histopathological examination revealed congested vein structures with thinning in the elastic layer. The lesions were therefore evaluated as true venous aneurysms. The patient was discharged the day after surgery, and remained asymptomatic for the next year.

Figure 1.

Multi-slice computed tomography depicts right external jugulary vein aneurysm (arrows).

We suggest that such venous aneurysms should be considered for surgery, because of important complications such as pulmonary embolism, thrombophlebitis, rupture and thrombus formations.² Although these are quite rare, it is important to keep such a rare entity in mind in the differential diagnosis of swellings in the neck region.