The louder the bigger: A case of jugular phlebectasia in a child

@#Jugular phlebectasia has been increasingly recognised with the advent of non-invasive diagnostic methods. Phlebectasia differs from varix, as it is an abnormal outward dilatation of a vein without tortuosity. It presents as a soft, compressible mass, apparent upon straining or execution of the Valsalva maneuver. The differentials for neck masses are broad, but if the swelling appears on the Valsalva maneuver, the type of mass narrows down to a laryngocele, superior mediastinal mass or phlebectasia. A simple non-invasive investigation, such as ultrasonography, is used as a diagnostic tool. We report a case of jugular phlebectasia that was suspected clinically and confirmed via ultrasound to be a vascular lesion which changed its size upon straining.

Internal Jugular Vein Phlebectasia : A Rare Case of Lateral Neck Swelling.

Internal Jugular vein Phlebectasia (IJP) is a rare disease in which there is a fusiform or saccular dilatation of Internal Jugular vein, usually presenting as a compressible neck mass that becomes prominent on coughing, straining or Valsalva manoeuvre. Colour Doppler is the non invasive diagnostic tool which clinches the diagnosis. It is important to keep this diagnosis in mind in case of lateral neck swellings to avoid invasive investigations and inappropriate treatment as management of asymptomatic case is conservative.

Diagnosis and treatment of jugular phlebectasia / 中国微创外科杂志

Objective To discuss the diagnosis and treatment of jugular phlebectasia. Methods Clinical data of 13 patients with jugular phlebectasia were reviewed. The confirmation of diagnosis in the nature, range, and degree of jugular phlebectasia was made using the Valsalva maneuver, color ultrasonography, and enhancement radiological techniques. Except 2 patients with superior mediastinal tumor were transfered to the Department of Thoracic Surgery, the treatment included resection of phlebangioma in 5 patients, internal jugular vein dilatation by balloon catheter in 1 patient, jugular venoplasty in 1 patient, and conservative treatment with Aspirin in 4 patients. Results In 7 surgically treated patients, the postoperative recovery was uneventful and no complications occurred. The length of hospital stay was 2~7 days (mean, 3 d). Follow-up observations in the 7 patients for 3~32 months (mean, 14.4 months) found no recurrence and excellent cosmetic outcomes. In 4 patients receiving conservative therapy, follow-up observations were carried out for 3~55 months. No changes were observed in 3 asymptomatic patients on the dilatation extent of the internal jugular vein and the range of the lesions, while improvements were achieved in 1 patient with symptoms after symptomatic treatment. Conclusions The diagnosis of jugular phlebectasia should be made for the patients who presented with a soft cystic fluctuant mass on the anterior neck which became more prominent during the Valsalva manoeuvre. The confirmation of differential diagnoses in the nature, range and degree of jugular phlebectasia can be made by enhancement radiological examinations. Minimally invasive surgery is recommended for the patients with symptomatic and cosmetic purposes.

Three Cases of Internal Jugular Phlebectasia

Phlebectasia is an abnormal dilatation of an isolated vein and a rare venous anomaly and is usually asymptomatic. Clinically internal jugular phlebectasia is a self limited benign condition and usually no treatment is required after initial diagnosis. So suspection of this disease and appropriate diagnostic approaches are essential to avoid unnecessary surgical intervention. We present three cases of internal jugular phlebectasia of which diagnosis was made by neck sonography and CT.

Diagnostic Criteria of Internal Jugular Phlebectasia in Korean Children

Internal jugular phlebectasia (IJP) is a fusiform dilatation of the internal jugular vein (IJV), usually presented as a neck mass in children. Accurate diagnosis from carefully directed history, physical examination, and radiological study could result in lifesaving therapy. We performed our study to suggest possible clinical diagnostic criteria for IJP in Korean children. We reviewed three cases of IJP (patients group) and compared the diameter of the internal jugular phlebectasias with diameters of IJVs in ten normal children (control group) using ultrasonography (USG). There were no significant differences in the range of diameters in the resting state between the two groups. The diameters on the right side, compared with those on the left side, showed no statistical significance (p < 0.05). Te range of expanding diameter and average expanding ratios (resting state to Valsalva maneuver X 100%) showed a statistical difference between the two groups (p < 0.05).

Two Cases of Jugular Phlebectasia / 대한이비인후과학회지

Anterior or lateral neck mass that appears on straining should be differentiated from laryngocele, jugular phlebectasia and superior mediastinal cysts or masses. The most common cause of aneck masses which that appears on straining is alaryngocele. The jugular phlebectasia may present itself in a similar manner, although it occurs rarely. The cause of the jugular phlebectasia is unclear. The diagnosis is made on a clinical basis and confirmed by the less invasive radiological technique. No treatment is indicated because of its self-limiting, benign condition. However, the surgical removal is needed for cosmetic purposes by a unilateral excision of the jugular vein. We experienced two cases of jugular phlebectasia, one anterior and the other internal. One case of The anterior jugular phlebectasia was successfully treated by surgical excision, and the other case of internal jugular phlebectasia was treated conservatively.

A Case of Bilateral Internal Jugular Phlebectasia / 대한이비인후과학회지

Phlebectasia is an abnormal dilatation of an isolated vein and a rare venous anomaly and is usually asymptomatic. Internal jugular phlebectasia is a localized, nonpulsatile, nontender, compressible, and saccular or fusiform dilatation that enlarges with Valsalva maneuver, sneezing, coughing and straining which increases intrathoracic pressure. Internal jugular phlebectasia predominantly affects young children and its etiology is idiopathic in most cases, but several predisposing factors have been suggested. Although histopathological findings of most cases had no significant abnormality, those of some cases showed elastic dysplasia, focal intimal thickening and muscular defect within the wall of the vein. A swelling in the neck which enlarges with Valsalva maneuver must be differentiated from other diseases. Internal jugular phlebectasia is most likely to be mistaken for laryngocele, superior mediastinal cyst or branchial cleft cyst. Diagnosis should be as non-invasive as possible because no treatment is indicated for this benign self-limiting condition. We present a case of bilateral internal jugular phlebectasia of which diagnosis was made by sonography with doppler technique and neck CT.