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Shetty ND, Dhande R, Parihar P, Unadkat BS, Bora N, Desale P. A Case of Phlebectasia in a Child Presenting With Neck Mass. Cureus 2023; 15:e48987. [PMID: 38111442 PMCID: PMC10726271 DOI: 10.7759/cureus.48987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 11/17/2023] [Indexed: 12/20/2023] Open
Abstract
Jugular phlebectasia is an enlargement of the jugular vein that manifests as a soft, cystic lump in the neck which can be compressed, becomes prominent on crying or straining and disappears on rest. It needs to be distinguished from laryngocele, neck cysts, and tumours that can also develop with straining. We report a case of a seven-year-old boy presenting with a cervical cystic mass. Comparable computed tomography and ultrasonography findings helped identify the pathology.
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Affiliation(s)
- Neha D Shetty
- Radiodiagnosis, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Rajasbala Dhande
- Radiodiagnosis, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Pratap Parihar
- Radiodiagnosis, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Bhavik S Unadkat
- Radiodiagnosis, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Nikita Bora
- Radiodiagnosis, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Prasad Desale
- Radiodiagnosis, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Management of an external jugular vein aneurysm in a young patient. J Vasc Surg Venous Lymphat Disord 2020; 8:861-863. [PMID: 32321691 DOI: 10.1016/j.jvsv.2020.03.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 03/04/2020] [Indexed: 11/22/2022]
Abstract
External jugular vein aneurysm (EJVA) is a rare clinical entity. A 23-year-old man presented with a spontaneous unilateral cervical swelling. Physical examination revealed a soft, nonpulsatile mass at the left supraclavicular region. Color duplex ultrasound combined with computed tomography confirmed the diagnosis of an EJVA. A surgical excision was accomplished without any complications during the early follow-up. EJVA mandates a high index of suspicion in the differential diagnosis of a neck mass. The open surgical approach seems to be a safe and effective therapeutic strategy.
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Stevens KE, Price JE, Marko J, Kaler SG. Neck masses due to internal jugular vein phlebectasia: Frequency in Menkes disease and literature review of 85 pediatric subjects. Am J Med Genet A 2020; 182:1364-1377. [PMID: 32293788 DOI: 10.1002/ajmg.a.61572] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 01/31/2020] [Accepted: 02/24/2020] [Indexed: 11/06/2022]
Abstract
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.
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Affiliation(s)
- Kristen E Stevens
- Section on Translational Neuroscience, Molecular Medicine Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland, USA.,George Washington University School of Nursing, Washington, District of Columbia, USA
| | - Julienne E Price
- Section on Translational Neuroscience, Molecular Medicine Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland, USA
| | - Jamie Marko
- Department of Diagnostic Imaging, NIH Clinical Center, Bethesda, Maryland, USA
| | - Stephen G Kaler
- Section on Translational Neuroscience, Molecular Medicine Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland, USA.,Center for Gene Therapy, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio, USA
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Figueroa-Sanchez JA, Ferrigno AS, Benvenutti-Regato M, Caro-Osorio E, Martinez HR. Internal jugular phlebectasia: A systematic review. Surg Neurol Int 2019; 10:106. [PMID: 31528444 PMCID: PMC6744733 DOI: 10.25259/sni-217-2019] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 05/01/2019] [Indexed: 01/21/2023] Open
Abstract
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.
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Affiliation(s)
- Jose A Figueroa-Sanchez
- Institute of Neurology and Neurosurgery, Hospital Zambrano Hellion, San Pedro Garza García, N.L., México
| | - Ana S Ferrigno
- Institute of Neurology and Neurosurgery, Hospital Zambrano Hellion, San Pedro Garza García, N.L., México
| | - Mario Benvenutti-Regato
- Institute of Neurology and Neurosurgery, Hospital Zambrano Hellion, San Pedro Garza García, N.L., México
| | - Enrique Caro-Osorio
- Institute of Neurology and Neurosurgery, Hospital Zambrano Hellion, San Pedro Garza García, N.L., México
| | - Hector R Martinez
- Institute of Neurology and Neurosurgery, Hospital Zambrano Hellion, San Pedro Garza García, N.L., México
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Chua E, Udom V, Huang DY. Internal jugular vein aneurysm in an adult: diagnosis on non-invasive imaging. BMJ Case Rep 2018; 2018:bcr-2017-223593. [PMID: 29545436 DOI: 10.1136/bcr-2017-223593] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
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.
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Affiliation(s)
- Elise Chua
- Medicine, King's College Hospital NHS Foundation Trust, London, UK
| | - Valerie Udom
- Department of Radiology, King's College Hospital, London, UK
| | - Dean Y Huang
- Department of Radiology, King's College Hospital, London, UK
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Internal jugular vein phlebectasia presenting with hoarseness of voice. Case Rep Vasc Med 2013; 2013:386961. [PMID: 24369523 PMCID: PMC3863558 DOI: 10.1155/2013/386961] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2013] [Accepted: 09/24/2013] [Indexed: 11/28/2022] Open
Abstract
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.
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Aydoğan F, Taştan E, Aydin E, Kürkçüoğlu M, Demir S. Bilateral internal jugular vein phlebectasia. EAR, NOSE & THROAT JOURNAL 2011; 90:E1-3. [PMID: 21412724 DOI: 10.1177/014556131109000312] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Phlebectasia is a dilation of a vein. Jugular vein phlebectasia can occur in any part of the jugular venous system. It is an uncommon cause of cervical swelling in children. We report a rare case of bilateral internal jugular vein phlebectasia presenting as bilateral neck swelling in a child. We also review the literature on the clinical features of this entity and the differential diagnosis, methods of imaging, and treatment.
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Affiliation(s)
- Filiz Aydoğan
- Department of Otorhinolaryngology, Ankara Education and Research Hospital, Ankara, Turkey.
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Mv Souza A, Guerra AF, Assis Lima TM, Campos Duprat AD. Jugular phlebectasia: A cause of neck swelling—Case report. ACTA ACUST UNITED AC 2008. [DOI: 10.1016/j.pedex.2008.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Guerrero Fernández J, Guerrero Vázquez J, García Ascaso MT, Olmedo Sanlaureano S, Luengo Casasola JL. Flebectasia de la vena yugular interna. An Pediatr (Barc) 2005; 63:86-8. [PMID: 15989883 DOI: 10.1157/13076779] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Abstract
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.
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Affiliation(s)
- V R Rajendran
- Department of Radiodiagnosis, Medical College, Calicut, Kerala, India.
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Bhalodiya N, Supriya M, Singhania A. Anterior jugular phlebectasia. Indian J Otolaryngol Head Neck Surg 2004; 56:123-4. [PMID: 23120049 DOI: 10.1007/bf02974314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Phlebectasia is abnormally dilated vinous channels a rare differential diagnosis for an apparent neck swelling A 5 year old male child with neck swelling apparent only on crying and speaking presented to us It was a soft cystic swelling The diagnosis was confirmed by sonography and angiography Surgical excision was carried out without any complication.
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Affiliation(s)
- Neena Bhalodiya
- Resident Department of Otorhinolaryngology, Head & Neck Surgery B J Medical College, Ahmedabad, ; Civil Hospital Campus, Flat No. 37, Professors Quarters, 380016 Asarwa, Ahmedabad
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Sakallioğlu AE, Yağmurlu A, Yağmurlu B, Gökçora HI. An asymmetric ballooning of the neck: Jugular vein aneurysm. J Pediatr Surg 2002; 37:111-3. [PMID: 11781999 DOI: 10.1053/jpsu.2002.29440] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The differential diagnosis and treatment of a 2-year-old boy with a left-sided cystic neck bulge enlarged in size while straining, coughing, and crying is presented. Contemporary diagnostic tools were of little value, whereas its location, variability in size, and consistency at physical examination played a major impact. Simple excision of the venous aneurysm was sufficient in its treatment.
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Affiliation(s)
- A Ebru Sakallioğlu
- Department of Pediatric Surgery University of Ankara, School of Medicine, Ankara, Turkey
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Abstract
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.
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Affiliation(s)
- V Paleri
- Department of Ear, Nose and Throat Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India.
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Abstract
BACKGROUND/PURPOSE Phlebectasia of the jugular veins is a venous anomaly that usually presents in children as a soft cystic swelling in the neck during straining. The purpose of this report is to discuss the differential diagnosis, the methods of imaging, the mode of treatment, and to demonstrate some factors that have made us believe that the condition may not be an actual rarity but rather has been ignored. METHODS Eight cases of unilateral internal jugular phlebectasia were treated surgically (ie, excision of the dilated portion of the vein) from 1987 to 1998. The age of the patients ranged from 3 to 14 years. There were 3 girls and 5 boys. The lesions were right sided in 6, and left sided in 2 children. The patients underwent surgery after comparative ultrasonographic confirmation of the diagnosis. Furthermore, the authors prepared a simple questionnaire for evaluating the level of knowledge about this lesion among the related specialists. One hundred ten physicians were asked to describe the jugular phlebectasia and its ideal treatment. RESULTS All of the patients were discharged from the hospital 24 hours after surgery. Follow-up periods ranged from 6 months to 6 years and no complaints were noted at the time of most recent visits. Our questionnaire results showed that 96% of 73 pediatricians, 37% of 22 otorhinolaryngologists, and 40% of 15 pediatric surgeons did not know what the jugular phlebectasia was. CONCLUSIONS Color Doppler sonography alone is sufficient for the diagnosis of jugular phlebectasia. The authors recommend surgical excision in asymptomatic cases for cosmetic and psychological purposes. The rarity of the lesion may be caused by a lack of knowledge among the related physicians and the tendency of reporting only surgical results.
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Affiliation(s)
- S Sander
- SSK Bakirköy Maternity and Children's Hospital, Department of Pediatric Surgery, Istanbul, Turkey
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Abstract
BACKGROUND Anterior neck mass which appears on straining should be differentiated from laryngocele, jugular venous system phlebectasia and superior mediastinal cysts or masses. Internal jugular phlebectasia is a fusiform dilatation of the internal jugular vein. PURPOSE this is an attempt to elucidate the etiology, clinical features, diagnosis, treatment and review of the literature about this rare venous lesion. METHODS an 11 year old boy presented with soft neck swelling on the right side which appeared on straining. The diagnosis was confirmed on the bases of ultrasonography combined with Doppler flow imaging and spiral computerized tomography scan with contrast. The patient was treated conservatively and followed up for 21 months without any changes. CONCLUSION internal jugular phlebectasia is a rare disease, which mostly involves the right side. It is usually a childhood disease and believed to be of congenital origin. It can occur at any age and affects both genders. Nevertheless no single case was reported in a young adult male. The diagnosis was made on a clinical basis and confirmed by less invasive radiologic technique. The investigations of choice are Doppler ultrasonography and spiral computerized tomography scan with contrast. Even though most of these lesions have been excised surgically, the treatment of choice should be conservative as long as it is asymptomatic.
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Affiliation(s)
- S al-Dousary
- Otolaryngology Department, King Abdulaziz University Hospital, Riyadh, Saudi Arabia
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Abstract
The most common cause of a mass in the neck appearing only during straining is a laryngocele. On the other hand, the rare jugular phlebectasia may present in a similar manner. The cause of the jugular phlebectasia remains unclear. No treatment is indicated for this benign self-limiting condition. However, surgical removal for cosmetic purposes alone consists of a unilateral excision of the internal or external jugular vein; this produces no gross side-effects. Conclusion. Every patient with a swelling in the neck that enlarges in size after the Valsalva manoeuvre, straining, coughing or sneezing should be suspected of having jugular phlebectasia.
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Affiliation(s)
- N Pul
- Department of Paediatrics of State Hospital, Edirne, Turkey
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