Vol.:(0123456789) 1 3 Internal and Emergency Medicine https://doi.org/10.1007/s11739-020-02514-w CE - MEDICAL ILLUSTRATION External jugular vein aneurysm: a rare cause of fuctuating neck swelling Ashwin Chandran 1  · Dhananjay Kumar 1  · Rajeev Kumar 2  · Nisha Sharma 3  · Rakesh Kumar 1 Received: 4 August 2020 / Accepted: 21 September 2020 © Società Italiana di Medicina Interna (SIMI) 2020 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-defned, 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 infammation 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 ultra- sound scan revealed a 30 × 25 mm homogenous, saccular, compressible structure which on colour Doppler identifed 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 confrming 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 disfguring appearance. The patient underwent surgical excision under local anaesthesia through a supraclavicular transverse skin crease incision two fnger-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). Patho- logic study confrmed the diagnosis of external jugular vein aneurysm (Fig. 1e). She had an uneventful postoperative period and remained symptom-free at 2-year follow up. Venous aneurysm is a condition in which there is an abnormal dilatation of the vein. It can be congenital (pri- mary) or acquired (secondary). Compared to arterial aneu- rysms the venous aneurysms are rare owing to low pressure within the venous system. The pathophysiology of venous aneurysm development is unknown and inflammation, degeneration of vessel wall, increased venous pressure due to intra or extra-luminal obstruction or congenital fragility of the venous wall are the proposed causes [1]. It commonly afects intracranial, thoracic, visceral, or extremity veins and rarely seen in cervical superfcial venous systems. Among the cervical veins, the aneurysm is common in internal jugular vein followed by external jugular vein and anterior jugular vein. The benign and malignant swelling of neck or thorax and thoracic outlet obstruction leading to increased pressure within in the vena cava, trauma to the vein or iatro- genic causes like venepuncture are the probable etiological factors. The EJV aneurysm is usually asymptomatic and the Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11739-020-02514-w) contains supplementary material, which is available to authorized users. * Rajeev Kumar rajeev9843@yahoo.co.in Ashwin Chandran ashjipmer@gmail.com Dhananjay Kumar dksss007@gmail.com Nisha Sharma nishadevanshi315@gmail.com Rakesh Kumar winirk@hotmail.com 1 Department of Otolaryngology, Head and Neck Surgery, All India Institute of Medical Sciences, New Delhi, India 2 Department of Otolaryngology, Head and Neck Surgery, All India Institute of Medical Sciences, New Delhi 110029, India 3 Department of Pathology, All India Institute of Medical Sciences, New Delhi, India