External Jugular Vein Aneurysm: A Rare Cause of Neck Swelling

Abstract

A 35-year-old man, normotensive, nondiabetic, a nonsmoker, and army personnel, presented with swelling on the right side of the neck, which appeared only after exercise or with exertion for the previous 6 months. The swelling was not associated with pain or difficulty with breathing or swallowing. He had no history of foul breath, regurgitation of food, trauma to the neck, or any surgical procedure. On examination, the swelling was not visible; however, it appeared when performing the Valsalva maneuver. It was soft, cystic, nontender, and compressible on palpation and measured approximately 3 × 1.5 cm at maximum expansion ( Figure 1A). There was no bruit on auscultation, and the swelling was not transilluminant.

Rare External Jugular Vein Pseudoaneurysm

“…4 (CT angiography, magnetic resonance imaging, and magnetic resonance venography can more accurately demonstrate size and extent, but are not first line. 5,6,8,11,12 Additionally, CT with intravenous contrast may be a suitable imaging modality in cases where ultrasound or clinical uncertainty requires a CT without angiography. To our knowledge this is the only case in the literature where an external jugular vein pseudoaneurysm was diagnosed with a contrast CT without angiography.…”

“…Venous aneurysms are classified as primary (congenital) and secondary (acquired). 2,5,8 Causes of primary venous aneurysms are not fully understood, 9,13 while possible etiologies for secondary aneurysms within the venous system include thoracic outlet obstruction, trauma, chronic inflammation, degeneration, and increased venous pressure. 2,4,5,11,14 Known risk factors for secondary venous aneurysms include recent trauma, cardiovascular disease, and age.…”

“…4,5,12,15 Enlargement of the mass with valsalva or excursion is suspicious for laryngocele, aneurysm, or pseudoaneurysm. 8,10 Complications may include pulmonary embolism, thrombus formation or thrombophlebitis, and rupture. 5,6,8,10,12 The research suggests there is risk of major embolic complications from jugular vein aneurysms.…”

“…[1][2][3][4][5][6][7] This is postulated to be related to the low pressure system in the superior vena cava. 2,3,6,8 Because of this 77% of venous aneurysms are located in lower extremities. 7 In addition, pseudoaneurysms of the external jugular vein are less common than aneurysms of the internal jugular vein, making them an exceedingly rare entity.…”

Saccular Aneurysm of the External Jugular Vein: An Unusual Cause of a Neck Mass

“…Differential diagnosis in an adult includes lymph node enlargement, laryngocele, thyroid lesion, thyroglossal/dermoid/branchial cysts, lipoma, cavernous hemangioma, pharyngeal pouch, malignant transformation of a neck cyst, and metastases from squamous cell carcinoma. 1-3,5-9,12,16…”