Unilateral right-sided internal jugular phlebectasia in asthmatic children

Internal jugular vein phlebectasia: A systematic review of therapeutic approaches in Pediatrics

OBJECTIVES

Internal jugular vein phlebectasia (IJVP) is a rare type of vascular abnormality that causes dilatation of internal jugular vein in the neck. There is presently no consensus on the most effective method of treatment for this condition, that is commonly seen in children. We conducted a systematic review of the literature reported till date to comprehend the key features of IJVP and its most effective therapeutic modalities.

METHODS

Five databases were searched until October 10, 2022 for articles of any design (including case reports) reporting IJVP in pediatric subjects. Individual patient data on demographics, clinical features of this entity and the differential diagnosis, methods of imaging, management, and outcome of illness were recorded. The quality assessment was performed using the Joanna Briggs Institute's Critical Appraisal Checklist for studies.

RESULTS

A total of 51 articles including 169 cases were retrieved and included in the analysis. Of the 169 patients, most of them were male children, and in 77% of cases right internal Juglar vein was involved. All patients had some symptoms suggestive of IJVP with most common ones being neck swelling or tenderness, and difficulty in breathing. In 90% of cases, it was observed that the neck swelling typically increases in size with Valsalva maneuver. Once jugular vein phlebectasia was clinically suspected, ultrasonography, CECT, or color Doppler flow imaging were used to confirm the diagnosis. The management of most of the cases was either conservative or surgical, and in surgery mostly ligation was performed. There have not been any cases of serious complications, therefore, according to included studies, a conservative approach is recommended with continuous monitoring. Out of the 51 studies included, most of them had low risk of bias.

CONCLUSION

Internal jugular vein phlebectasia, a rare benign condition, is most commonly found in children, and affects predominantly the right internal jugular vein. Although most patients did well with merely conservative treatment, still management of this vascular anomaly has to be on a case-by-case basis.

Bilateral internal jugular vein ectasia: A rare cause of neck swelling

Internal jugular vein ectasia or phlebectasia is a condition in which there is an isolated fusiform dilatation of the internal jugular vein. The patient usually presents with swelling in the neck, which aggravates in size while coughing or straining. This is a rare condition and is often mis-diagnosed. It can be diagnosed by proper history, clinical examination and imaging. We report a 5-year-old boy who had bilateral internal jugular vein ectasia aggravating in size while straining and coughing. Ultrasonography and computed tomography scan showed dilatation of internal jugular veins on both sides. Since the patient was asymptomatic and had no complications, he was advised regular follow-up. This rare benign condition should be kept in mind as a differential diagnosis of an expansile neck mass.

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.

Pulsatile Tinnitus Caused by Internal Jugular Phlebectasia in an Adult

Internal jugular phlebectasia is a rare condition. Children with internal jugular phlebectasia are often discovered by their parents when they notice a soft mass in the neck that appears when the child cries, coughs, or breathes deeply. Most internal jugular vein dilatations occur unilaterally on the right side according to the literature reports. To our knowledge, no other internal jugular phlebectasia patients reported pulsatile tinnitus as the major complaint without a soft mass in the neck. The authors reported a female adult patient with left-side internal jugular phlebectasia with pulsatile tinnitus as the major complaint without a soft mass in the neck. Internal jugular phlebectasia was diagnosed by color ultrasound of the internal jugular vein. Pure-tone audiometry, tympanometry, hemoglobin, thyroid function, and magnetic resonance imaging were made to differentiate other diseases that can cause the pulsatile tinnitus. Conservative treatment is recommended in this report. The possibility of internal jugular vein dilatation should be considered when differentiate the possible diseases that caused pulsatile tinnitus.

Internal jugular phlebectasia: A systematic review

Background:

Internal jugular phlebectasia (IJP), the abnormal dilatation of internal jugular vein, is generally considered a benign anomaly. However, because IJP is uncommon, little is known about its natural history, and currently, no consensus on the best treatment modality is available.

Methods:

The purpose of this article is to conduct a systematic review of available literature on recently reported IJP cases to understand the main characteristics of IJP and its most frequent therapeutic approaches. Following the preferred reporting items for systematic reviews and meta-analyses guidelines, literature search for IJP cases was conducted in the COCHRANE, PUBMED, EBSCOHOST, SCOPUS, OVID, and SCIELO databases.

Results:

A total of 97 original articles were found, with a total of 247 IJP cases reported including both pediatric and adult patients.

Conclusions:

To the best of our knowledge, this study is the largest systematic review analyzing all the reported cases of IJP. IJP is considered by most authors as a benign abnormality that predominantly affects the right jugular vein. It is most commonly diagnosed in children. At present, conservative treatment is preferred for pediatric but not for adult patients. Multicenter randomized prospective studies are required to further understand this rare anomaly.

Internal jugular vein aneurysm in an adult: diagnosis on non-invasive imaging

We report the case of a 48-year-old man with a right fusiform internal jugular venous aneurysm, presenting as a unilateral painless neck swelling on coughing or laughing. This is a rare condition, more commonly seen in the paediatric population and can be diagnosed using non-invasive modalities such as Doppler ultrasound and contrast-enhanced CT. This anomaly is frequently misdiagnosed or overlooked, and our case highlights the importance of considering venous aneurysm as a differential to prevent invasive imaging and inappropriate management.

Dysphagia because of unilateral internal jugular vein phlebectasia in an infant

Phlebectasia affecting the internal jugular vein is a rare cause of a benign neck swelling in children. They are mostly asymptomatic and therefore managed conservatively. Ligation of the vein and excision is usually avoided owing to the worry of raised intracranial pressure. We report a case of a large right internal jugular vein phlebectasia, causing dysphagia in a 7month old male child. Contrast enhanced computed tomography with 3-D reconstruction helped in pre-operative anatomical delineation, especially of the lower extent. It was excised through a cervico-thoracic approach with postoperative amelioration of symptoms. Contrary to expectation, the ectasia was not friable and was covered with a pseudocapsule of fibrofatty tissue, making excision easy.

Jugular phlebectasia: clinical scenario in India

Jugular phlebectasia is fusiform dilatation of internal jugular vein seen in childrens. It usually occurs in children but can occur at any age. It usually presents as unilateral swelling in the neck found during coughing and shouting. It is usually asymptomatic, so it is often ignored or misdiagnosed. Differential diagnosis include laryngocele, cavernous hemangioma, cystic hygroma, branchial cyst. Treatment is usually conservative as complications like thrombosis and horners syndrome are very rare. Non invasive investigations like Doppler sonogram and are usually done to diagnose this condition. We report two cases of jugular phlebectasia, who presented to our out patient department with history of swelling in the right side of neck which increases on crying and shouting. Doppler sonogram and ultrasound was done to diagnose the condition. There seems be lack of knowledge among medical fraternity in various specialities. So a questionnaire was prepared to assess the knowledge among resident doctors, general practitioners, Otorhinolaryngologists, paediatricians. Questionnaire was posted in social networking sites and the feedback was obtained. Out of the 150 interns in our hospital, only one (0.66 %) was able to explain about the condition. In general practitioners group containing 369 respondents, only 4 (1.08 %) knew the condition and have seen patients. A pediatricians group containing 312 respondents only 23 (7.37 %) pediatricians knew the condition, 289 (92.62 %) persons had no idea about the treatment. Otorhinolaryngologists group containing 328 respondents. 21 (6.40 %) knew the condition, 293 (89.3 %) have no idea. The Chi square test shows that the specialty of the respondent like pediatrician and ENT practitioner have more knowledge than the other for jugular phlebectasia at p < 0.0001.

Internal jugular vein phlebectasia presenting with hoarseness of voice

Internal jugular phlebectasia presents as a soft cystic mass in the neck that appears on straining. We present a case of a 7-year-old girl who presented with a painless soft cystic mass in the neck associated with hoarseness of voice. Based on clinical examination and CT image, diagnosis of right internal jugular phlebectasia was made.

Phlebectasia of internal jugular vein

Internal jugular phlebectasia (IJP) is a rare disease in which there is a fusiform dilatation of internal jugular vein, usually presenting as a neck mass in children. Accurate diagnosis from careful history, physical examination, and radiological study can be made. We report a 12-year-old boy with history of swelling appearing on the right side of the neck only on straining, coughing, or during a Valsalva maneuver. Diagnosis of right IJP was made. Exploration and wrapping the dilated segment in an 8-mm-diameter polytetrafluoroethylene tube graft was done. Because of its rarity, this entity is frequently ignored or misdiagnosed. This case report intends to stress the importance of keeping IJP as differential diagnosis while dealing with such a swelling to avoid invasive investigations and inappropriate treatment.

Asymptomatic thymic cyst appearing in the neck on valsalva: unusual presentation of a rare disease

Thymic cysts are usually diagnosed accidentally during radiological evaluation of the chest for unrelated conditions. Symptoms appear late when the mass compresses on adjoining tissues. We report an unusual case of asymptomatic mediastinal thymic cyst which was seen in the neck whenever the patient was asked to perform Valsalva maneuver. This case is being reported for the unusual clinical presentation of a rare disease. The role of imaging in the diagnosis and common differential diagnoses are also discussed.

Surgical repair of left internal jugular phlebectasia

Jugular vein phlebectasia, a fusiform dilatation of a vein without tortuosity, is a rare cause of cervical neck swelling in children. It commonly presents as a soft cystic mass in the neck that transiently appears during straining. Because of its rarity, jugular vein phlebectasia cases have frequently been misdiagnosed or have been managed inappropriately. This report describes the case of a left-sided internal jugular phlebectasia in a 4-year-old child that was surgically treated with a resection and an end-to-end repair.

Imaging of cystic or cyst-like neck masses

Cystic or cyst-like neck masses form a unique category within head and neck radiology with unique differential diagnoses. The precise anatomical location and imaging appearances are important for accurate diagnosis and formulating the differential diagnoses of cystic lesions in the neck. In vast majority of cases ultrasound, sometimes supplemented by fine-needle aspiration cytology (FNAC), is adequate for pre-treatment assessment. For large, deep-seated lesions assessment using magnetic resonance imaging (MRI) or computed tomography (CT) often provides useful supplementary information. Radiologists should be aware of imaging findings of common cystic neck masses to help in their appropriate management.

Surgical treatment of jugular vein phlebectasia in children

BACKGROUND

Jugular vein phlebectasia (JVP) is a cervical mass that occurs relatively infrequently and usually presents in children as a soft cystic swelling in the neck during straining. It is liable to be misdiagnosed or managed inappropriately. This report elucidates the clinical presentation, diagnosis, treatment choices, and postoperative complications of JVP, and diagnostic methods and treatment choices are recommended.

METHODS

Fifty-one cases of JVP were reviewed (right vein in 38 patients, left in 7 patients, and bilateral in 6 patients). The internal jugular vein was involved the most frequently. The main complaint was a soft and compressible mass in the neck, becoming more prominent with the Valsalva maneuver. All of the children except 2 had an ultrasound or color Doppler flow imaging (CDFI) performed in combination with the Valsalva's breathing test. Surgical intervention was performed in 46 patients and the other 5 patients were followed-up conservatively for 2 to 15 years.

RESULTS

Ultrasound or CDFI showed local dilatation of unilateral or bilateral veins in all patients except 2, and confirmed the diagnosis in combination with the Valsalva's breathing test. Surgical intervention included ligation of the involved jugular vein in 32 patients, and longitudinal constriction suture venoplasty plus encapsulation with medical Dacron cloth or PTFE in 14 patients. All of the children who had surgery recovered uneventfully, except 3 patients undergoing ligation of the right internal jugular vein.

CONCLUSIONS

The Valsalva maneuver was most important for establishing the diagnosis. Ultrasound or CDFI, or in combination with the Valsalva's breathing test, was the diagnostic procedure of choice to confirm the diagnosis of JVP because of its clarity, safety, and low cost. Surgical intervention was recommended for cosmetic and psychologic purposes. Ligation or excision of the involved jugular vein was very safe, simple, and effective for most patients. However, in cases of lesions of the right and bilateral internal jugular veins, longitudinal constriction suture venoplasty plus encapsulation might be more preferable and safer, and should be recommended. Otherwise, treatment should be conservative (follow-up evaluation).

Congenital jugular vein phlebectasia

BACKGROUND/PURPOSE

The purpose of the present study was to elucidate the clinical presentation, diagnosis, treatment, and postoperative complications of jugular vein phlebectasia (JVP), and to recommend diagnostic methods and treatment choices.

MATERIALS AND METHODS

Thirty-six cases of JVP were reviewed (right vein in 27, left in 6, and bilateral in 3). The internal jugular veins were the most commonly involved. The main complaint was the soft and compressible mass in the neck. Ultrasound or color Doppler flow imaging (CDFI) was performed on all the children. Surgical intervention was performed in 32 cases, and the other 4 cases were conservatively followed up for 4 to 6 years.

RESULTS

Ultrasound or CDFI demonstrated local dilatation of the unilateral or bilateral veins in all the patients. Surgical intervention included ligation of the involved jugular vein in 31 cases and draping with medical Dacron cloth in 1 case. All of the operated children recovered uneventfully, except 3 for cases who underwent ligation of the right internal jugular vein.

CONCLUSIONS

Valsalva maneuver was most important for establishing the diagnosis. Ultrasound or CDFI was the diagnostic procedure of choice to confirm the diagnosis of JVP. Surgical ligation or excision of unilateral jugular vein was recommended for cosmetic and psychological purposes. However, special attention must be paid to prevent postoperative complications in case of ligation of right internal jugular vein. Or else, treatment should be conservative (follow-up).

Unilateral internal jugular phlebectasia

Jugular phlebectasia is a rare cause of cervical swelling in children. It is a fusiform dilatation of any part of the jugular venous system and can involve the external, internal or anterior jugular veins. Previous reports suggest that the entity is often ignored or misdiagnosed. Unilateral internal jugular phlebactasia presenting as an intermittent neck swelling in a ten-year-old girl is reported. The clinical features are analyzed and the appropriate use of noninvasive imaging modalities is highlighted. The literature is also briefly reviewed.