Internal Jugular Vein Phlebectasia

Article information

J Neurosonol Neuroimag. 2024;16(2):107-108

Publication date (electronic) : 2024 December 31

doi : https://doi.org/10.31728/jnn.2024.00162

Sun Yoon Chung, MD^*, Sang Won Han, MD^,†

^*Department of Neurosurgery, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea

^†Department of Neurology, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea

Correspondence: Sang Won Han, MD Department of Neurology, Sanggye Paik Hospital, Inje University College of Medicine 1342 Dongil-ro, Nowon-gu, Seoul 01757, Korea Tel: +82-2-950-1090 Fax: +82-2-950-1955 E-mail: swhan@paik.ac.kr

Received 2024 November 4; Revised 2024 November 27; Accepted 2024 December 1.

Internal jugular vein (IJV) phlebectasia is a rare venous malformation presenting with neck swelling. IJV phlebectasia is a congenital saccular or fusiform dilatation of the jugular vein, appearing as a soft compressible neck mass during straining or the Valsalva maneuver, which increases intrathoracic pressure.1,2 IVJ is known as a congenital venous cyst or venous ectasia.2,3 Although commonly diagnosed in childhood, it may be seen in adults, often incidentally.1

A 56-year-old woman visited a neurology outpatient clinic complaining of swelling in the right neck during straining. The patient experienced symptoms for several months but ignored them. There were no medical conditions or preceding events, such as neck trauma or surgery, which could explain the symptoms. Upon inspection, a palpable mass was visible as it bulged on the right side of the neck during the Valsalva maneuver. Upon physical examination, the mass was nontender and easily compressed. Carotid duplex ultrasonography showed an engorged right IJV, which was easily compressed and became more prominent during the Valsalva maneuver (Fig. 1A: diameter of 2.80×1.27 cm, Fig. 1B: diameter of 1.53 cm). Doppler ultrasonography revealed unidirectional laminar flow with no thrombosis in the right IJV. Brain computed tomography (CT) angiography revealed a dilated right IJV, suggesting phlebectasia (Fig. 1C). Brain magnetic resonance venography confirmed right IJV phlebectasia (Fig. 1D).

Fig. 1.

Carotid duplex ultrasonography (CDU), brain computed tomography angiography (CTA), and magnetic resonance venography (MRV). (A, B) CDU and color Doppler ultrasonography show a dilation and engorged right internal jugular vein (IJV) in transverse (diameter of 2.80×1.27 cm) and longitudinal (diameter of 1.53 cm) view. (C) CTA demonstrates a dilated right IJV, suggesting phlebectasia in axial and coronal slices (arrow). (D) MRV confirms the right IJV phlebectasia (arrow).

IJV phlebectasia occurs more frequently on the right side because of anatomical factors.3,4 Its benign nature means that it is usually asymptomatic and characterized by a mass that increases in size with increased intrathoracic pressure. Diagnosis involves imaging techniques, such as ultrasonography and CT.1 Differential diagnoses for non-pulsatile compressible neck masses should include a laryngocele, laryngeal diverticulum, branchial cyst, cystic hygroma, cavernous hemangioma, and superior mediastinal cysts.1-3 Conservative treatment is recommended for asymptomatic patients. Surgery is advised for symptomatic patients, and cosmetic and psychological reasons.3