Bilateral internal jugular vein ectasia: a report of two cases

Neck masses due to internal jugular vein phlebectasia: Frequency in Menkes disease and literature review of 85 pediatric subjects

Classic Menkes disease is a rare X-linked recessive disorder of copper metabolism caused by pathogenic variants in the copper transporter gene, ATP7A. Untreated affected individuals suffer failure to thrive and neurodevelopmental delays that begin at 6-8 weeks of age and progress inexorably to death, often within 3 years. Subcutaneous injections of Copper Histidinate (US Food and Drug Administration IND #34,166, Orphan product designation #12-3663) are associated with improved survival and neurological outcomes, especially when commenced within a month of birth. We previously identified internal jugular vein phlebectasia (IJP) in four Menkes disease subjects. This feature and other connective tissue abnormalities appear to be consequences of deficient activity of lysyl oxidase, a copper-dependent enzyme. Here, we report results from a prospective study of IJP based on 178 neck ultrasounds in 66 Menkes subjects obtained between November 2007 and March 2018. Nine patients met the criterion for IJP (one or more cross-sectional area measurements exceeding 2.2 cm² ) and five subjects had clinically apparent neck masses that enlarged over time. Our prospective results suggest that IJP occurs in approximately 14% (9/66) of Menkes disease patients and appears to be clinically benign with no specific medical or surgical actionability. We surveyed the medical literature for prior reports of IJP in pediatric subjects and identified 85 individuals and reviewed the distribution of this abnormality by gender, sidedness, and underlying etiology. Taken together, Menkes disease accounts for 16% (15/94) of all reported IJP individuals. Neck masses from IJP represent underappreciated abnormalities in Menkes disease.

Internal jugular phlebectasia in an African adult

Jugular vein phlebectasia is a rare venous anomaly commonly presenting as a unilateral neck swelling in children and adults. Its aetiology is unknown and its detection may have increased with availability of better imaging facilities. Due to its rarity, a high index of suspicion is required once other causes of neck swelling are excluded. The few reported cases are mainly in children and non-Africans adults. The authors report the case of a 54-year-old Nigerian woman presenting for the first time with a progressive, intermittent, painless right neck swelling, which was demonstrated on Doppler ultrasound and CT angiography to be an internal jugular phlebectasia. She had satisfactory surgical excision of the dilated segment for cosmetic reasons.

Jugular phlebectasia: theory of pathogenesis and review of literature

Jugular phlebectasia is an entity that is being increasingly recognised in recent years. The term phlebectasia indicates dilatation of the vein without tortuosity. It has been described in almost all cervical veins. Internal jugular phlebectasia is seen more often on the right side. This paper reports two new cases, reviews all cases of internal jugular phlebectasia in children published in English literature upto 1996 and recommends diagnostic methods and treatment policy. This article also discusses a theory of pathogenesis for this condition based on the regional anatomical features, principles of vascular physics and pathologic findings.

Diagnostic role of ultrasonography in neck swellings

Diagnostic Role of Ultrasonography in Neck Swellings The study of ultrasonographic features of various neck swellings in fifty patients was done. There were 22 thyroid and thyroid related swelling, 8 salivary gland lesions, 9 lymph nodes and 14 swellings of miscellaneous origin. Various ultrasonographic features like echogenicity, echotextures were noted. There were no specific echogenicity in benign and malignant thyroid neoplasms. Various ultrasonographic features of benign and malignant salivary neoplasms and lymph nodes are described. Specific sonographic features of various miscellaneous neck swellings are also described.

Internal jugular phlebectasia--an unusual cause of neck swelling

We describe a 7-year-old child who presented with a soft fluctuant swelling on the neck which became more prominent during the Valsalva manoeuvre. He underwent adeno-tonsillectomy based on a mistaken diagnosis of ballooning of the pharynx secondary to enlarged adenoids and tonsils obstructing the nasopharyngeal and oropharyngeal airways. Investigations revealed the swelling to be a markedly dilated internal jugular vein. We discuss the diagnostic features and mode of treatment of this condition so as to avoid unnecessary and dangerous surgical intervention.