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.

A Rare Presentation of Thyroid Mass as Tubercular Abscess: A Case Report

Isolated thyroid gland tuberculosis is a rare disease, while even rarer is its presentation as an acute abscess. Here we present the case of a 65-year-old female who presented with a neck swelling which progressed to an abscess with multiple discharging sinuses which was proven to be tubercular abscess on histopathology.

Lemierre syndrome: a hidden complication of sore throats

BACKGROUND

Lemierre syndrome is a rare but potentially life-threatening condition characterized by septic thrombophlebitis of the internal jugular vein, most commonly caused by Fusobacterium necrophorum.

CASE PRESENTATION

A 46-year-old woman with no significant medical history presented with generalized neck swelling and fever. Despite seeking medical attention at multiple outpatient clinics for upper respiratory symptoms lasting 10 days, she only received symptomatic treatment for acute viral pharyngitis. A computed tomography (CT) scan of her neck revealed thrombophlebitis in the left internal jugular vein, and subsequent cultures indicated the presence of Klebsiella pneumoniae. The patient's oxygen saturation levels suddenly dropped, and the CT scan identified bilateral peripheral consolidation areas in both lungs, consistent with septic emboli. These findings were consistent with a diagnosis of Lemierre syndrome. The patient was treated with 2 weeks of intravenous piperacillin/tazobactam and vancomycin, as well as anticoagulation therapy using heparin, and her symptoms resolved completely.

CONCLUSION

This report presents an unusual occurrence of Lemierre syndrome caused by K. pneumoniae, a less frequently encountered causative pathogen in patients without diabetes mellitus. The case highlights the significance of timely and appropriate antibiotic use to prevent potential complications.

Delayed diagnosis of bacterial cervical lymphadenitis in the tropics: a case report

BACKGROUND

Lymphadenopathy refers to any disease process involving lymph nodes that are abnormal in size and consistency. There are multiple etiologies in the setting of a diseased lymph node, including conditions of infection, autoimmune diseases, and neoplasia. Lymphadenitis is a term that refers to lymphadenopathies that are due to inflammatory processes and can represent an acute bacterial infection resulting from streptococcal pharyngitis or a prior viral upper respiratory infection. Cervical lymphadenopathy refers to nodal swelling in the neck region. While cervical lymphadenitis is a common clinical finding in the setting of a transient response to a benign local or generalized infection, it may evade detection sometimes and thus account for a percentage of misdiagnosis or delayed diagnosis in the tropics. This case report is aimed at increasing the awareness about the presentation of bacterial cervical lymphadenitis and how it can sometimes mimic the presentation that is typical and regularly found with plasmodiasis. It contributes to improved awareness and high index of suspicion in clinic when dealing with patients in the tropics.

CASE PRESENTATION

We present a case of delayed diagnosis of bacterial cervical lymphadenitis that initially presented with typical features of malaria from Plasmodium falciparum. A 26-year-old Nigerian woman presented to the outpatient department following complaints of a recurring fever of a month's duration and bilateral neck swelling of about 2 weeks prior to presentation.

CONCLUSION

In the setting of a busy clinic, details are easily missed and salient features in the presentation of a patient that are needed for accurate diagnosis and management could go unrecognized. Hence, this case report highlights the importance of proper examination particularly of lymph nodes and use of different diagnostic modalities for the exact diagnosis of disease.

A rare case of hydatid cyst of the neck with concurrent pulmonary hydatid disease

Echinococcosis, commonly known as hydatid disease, is a zoonotic infection caused by dog tapeworm Echinococcus granulosus. Hydatid disease of the head and neck region is scarcely reported even in endemic areas. We herein report a case with with neck swelling and respiratory symptoms subsequently diagnosed to have disseminated echinococcosis of the neck and left lung.

Primary Hydatid Cyst of Neck, A Rare Case Report

Hydatid cyst is a result of parasite infection. The neck is an uncommon site for this infection so it is not considered as a differential diagnosis of neck swelling commonly. We hereby report a case of 24 year female with left postero-lateral neck swelling for 5 years that was insidious in onset and gradually increased in size. We diagnosed the case as hydatid cyst of neck on FNAC and MRI. Pre operatively oral albendazole was given for 1 month and continued post operatively. Our case has not shown recurrence for 6 months after successful surgical excision. So primary hydatid cyst should be considered as a differential diagnosis of neck swelling and should be treated accordingly.

Retropharyngeal edema: A rare manifestation of eosinophilic granulomatosis with polyangiitis

Eosinophilic granulomatosis with polyangiitis (EGPA) is characterized by excessive eosinophil accumulation in the peripheral blood and affected tissues with development of granulomatous vasculitic organ damage. Although upper airway and neck involvement is seen in patients with EGPA, retropharyngeal inflammation has never been reported. We report a case of retropharyngeal edema in a 70-year-old woman with EGPA. Her symptoms improved and the retropharyngeal edema disappeared on computed tomography following treatment. EGPA should be considered as a differential diagnosis in patients with asthma presenting with neck swelling and dysphagia.

Hydatid disease as a rare cause of neck swelling: Two cases report

INTRODUCTION

Despite the fact that hydatid disease is endemic in some countries, its cervical location remains very rare.

PRESENTATION OF CASE

We report two cases of primary cervical hydatid disease in two children from rural areas. The imaging was not specific, since the location is rare; the diagnosis was only confirmed after surgery.

DISCUSSION

Hydatid cyst is a rare pathology. Thus clinical presentation, radiological examinations, fine needle aspiration and serology can be useful to suspect the diagnosis.

CONCLUSION

Hydatid disease should be considered when dealing with slow-growing renitent neck swelling in endemic countries.

The effect of point-of-care ultrasound on length of stay in the emergency department in children with neck swelling

BACKGROUND

Ultrasound is the imaging modality of choice in children presenting to the emergency department (ED) with soft tissue neck swelling. Point of care ultrasound (POCUS) has good accuracy when compared to comprehensive radiology department ultrasound (RADUS). POCUS could potentially improve ED length of stay (LOS) by improving efficiency. We aimed to evaluate the LOS of pediatric patients seen in ED with soft tissue neck swelling who received POCUS compared to RADUS. We determined unscheduled 30-day return visit rates in both groups as a balancing measure.

METHODS

We performed a retrospective review of the electronic medical record for our cross-sectional study of discharged patients ≤21 years of age who had a neck ultrasound performed by a credentialed POCUS physician or by the radiology department between July 2014 and January 2020. We included patients who had both POCUS and RADUS in the POCUS group. We compared median ED LOS in both groups using the Mann Whitney U test and proportion of unscheduled return visits to the ED in both groups using odds ratio and 95% CI.

RESULTS

There were 925 patients: 76 with only POCUS, 6 with POCUS and RADUS, and 843 with only RADUS performed. Median LOS in the POCUS group was 68.5 min (IQR 38.3120.3) versus 154.0 min (IQR 111.0, 211.0) in the RADUS group (p < 0.001). Return visit overall was 7.6%: 13.2% in the POCUS group versus 7.1% in the RADUS group (p = 0.07).

CONCLUSION

Pediatric patients evaluated in the ED for soft tissue neck swelling had a shorter LOS with POCUS than with RADUS without a statistically significant increase in 30-day return visits. We suggest a "POCUS First" approach to the care of these patients.

A non-alcohol-related case of Madelung's disease: Challenging patient with progressive jugular vein distension

Madelung's disease or multiple symmetric lipomatosis (MSL) is a rare benign disease characterized by abnormal, multiple and symmetric fat depositions in the subcutaneous layer, involving head, neck, back, trunk and also upper and lower limbs. MSL may be related to alcohol abuse or metabolic disorders; it may be both silent or clinically manifest. We describe a case of a 48-yo man with β-thalassemia admitted to medicine department for neck swelling without fever or respiratory symptoms. Patient denied a history of alcoholism and laboratory exam excluded metabolic disorders. Doppler ultrasound, contrast Enhanced-CT and Magnetic Resonance Imaging exams of the neck showed a symmetric, non-encapsulated fat deposition causing extrinsic compression of the right jugular vein without thrombosis. Once excluded the possibility of malignancy, patient's history, clinical, and radiological findings suggest the diagnosis of non-alcohol-related MSL disease. Knowing MSL imaging findings and its degree is crucial to guide towards the right management. Our patient did not require surgical treatment and an US follow-up is needed in order to detect any possible evolution.

Sudden neck swelling with rash as late manifestation of COVID-19: a case report

BACKGROUND

Although there are reports of otolaryngological symptoms and manifestations of CoronaVirus Disease 19 (COVID-19), there have been no documented cases of sudden neck swelling with rash in patients with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection described in literature.

CASE PRESENTATION

We report a case of a sudden neck swelling and rash likely due to late SARS-CoV-2 in a 64-year-old woman. The patient reported COVID-19 symptoms over the previous three weeks. Computed Tomography (CT) revealed a diffuse soft-tissue swelling and edema of subcutaneous tissue, hypodermis, and muscular and deep fascial planes. All the differential diagnoses were ruled out. Both the anamnestic history of the patient's husband who had died of COVID-19 with and the collateral findings of pneumonia and esophageal wall edema suggested the association with COVID-19. This was confirmed by nasopharyngeal swab polymerase chain reaction. The patient was treated with lopinavir/ritonavir, hydroxychloroquine and piperacillin/tazobactam for 7 days. The neck swelling resolved in less than 24 h, while the erythema was still present up to two days later. The patient was discharged after seven days in good clinical condition and with a negative swab.

CONCLUSION

Sudden neck swelling with rash may be a coincidental presentation, but, in the pandemic context, it is most likely a direct or indirect complication of COVID-19.

Salmonella Thyroid Abscess Treated by Serial Aspiration: Case Report and Literature Review

Thyroid abscesses are the most rare conditions of the thyroid gland but it could be potentially life threatening. Most patients are immunocompromised or has an underlying chronic thyroid disorder. We report a case of a 58 year-old lady with underlying uncontrolled diabetes mellitus and a long standing uninvestigated goiter who presented with lethargy, a new anterior neck swelling with dysphagia and change of voice. Ultrasound and computed tomography were performed and showed collection with multiple air pockets in the right thyroid lobule extending to the anterior mediastinum. She was started on intravenous antibiotics and underwent serial bedside aspiration. Her symptoms improved and complete resolution was achieved after serial aspirations and antibiotics.

Hypoglossal schwannomas: A systematic review of the literature

BACKGROUND

Schwannomas of the hypoglossal nerve are rare and account for a very small percentage of non-vestibular schwannomas.

OBJECTIVES

In this systematic review of the literature, we examined the epidemiology, symptomatology, management, and outcomes of patients with hypoglossal schwannomas.

METHODS

The electronic database Pubmed was searched for all reports of hypoglossal schwannomas with descriptions of symptoms, management, and outcome characteristics. Data was extracted from each study and compiled in a spreadsheet. Continuous variables were reported as means and medians. Categorical variables were reported as proportions. Additional analysis was not done due to inconsistent reporting of outcomes and small sample sizes.

RESULTS

A total of 59 studies (94 total individual cases) were included. 64% of patients were female with mean age of 44.6 years. The majority were intracranial/extracranial (50%). The most common symptoms were tongue deviation or speech disturbance (38%) and headaches (33%). Hypoglossal nerve dysfunction was present in 80% of patients. Surgical excision was performed in 93%, with a 15% complication rate. Evidence of residual mass after surgery was noted in 29%. Permanent hypoglossal nerve deficits occurred in 67%. Recurrence of tumor burden was reported in 6 studies, with median time to recurrence of 16.5 months.

CONCLUSION

Current evidence suggests overall favorable outcomes with surgical resection of hypoglossal schwannomas, with a large percentage of patients experiencing mild and usually well-tolerated neurologic deficit. Limitations of this study include the use of retrospective data taken from case reports/series with highly selected patients, selective reporting, and absence of control groups.

A case report of Lipoblastoma: Presenting as a swelling in the nape of the neck of 14 years old girl

INTRODUCTION

Lipoblastoma usually develops in extremities and trunk during infancy or childhood. Its occurrence in head and neck is rare.

CASE PRESENTATION

Here we present a case of lipoblastoma in 14 years old female who developed swelling in the nape of her neck. Initially the diagnosis of lymphangioma was made on the basis MRI findings but histopathology after excisional biopsy confirmed it to be lipoblastoma.

CONCLUSION

Lipoblastoma can rarely present as swelling in the nape of neck in adolescents.

Huge thyroglossal duct cyst in elderly patient: Case report

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85 years old male with huge long-standing (>60 years long) mid-line neck swelling.

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Clinical characters and radiology was consistent with Thyroglossal Duct Cyst.

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Sistrunk operation was successful, and pathology confirmed diagnosis.

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Healing was good, with no recurrence.

Introduction

Thyroglossal duct cyst is the most common congenital neck mass. About 50% of cases present before the age of 10. A second group present in young adulthood.

Case

We present a case of an 85 years old male patient who presented to us with a huge swelling occupying the whole front of the neck, matching the characters of a thyroglossal cyst by history and clinical examination. The swelling first appeared in early adulthood. He received faulty advice that led him to believe that the operation was too risky. He lived without treatment or complications except for very slow progressive enlargement of the swelling over the years until it became cosmetically very bad and interfering with his daily activities. The swelling was cystic, non-tender with surrounding healthy skin except small area showing minimal signs of inflammation. Neck US and (CT) confirmed the diagnosis of thyroglossal cyst, 92*76 mm in size.

Intervention

We performed surgical excision of the cyst, tract and central part of hyoid bone (Sistrunk operation) and sent the specimen for histopathological evaluation, which confirmed pre-operative diagnosis.

Conclusion

Diagnosis of TGDC shouldn’t be excluded even in extremes of age, or extreme size, and can be managed according to standard lines of management.

Ectopic Intratracheal Thyroid Tissue Leading to Stridor

Ectopic thyroid is a condition in which the thyroid tissue is present outside its normal anatomical position. Usually the ectopic thyroid is present along the line of its migration. The presence of ectopic thyroid tissue within the trachea is a very rare condition. Surgery is appropriate treatment for patients with ectopic thyroid tissue with clinical signs of upper airway obstruction. Here we present such a case where an ectopic intratracheal thyroid was causing airway obstruction.

Neck swelling due to skull base (pseudo)meningocele protruding through a congenital skull base bone defect: a case report

BACKGROUND

Meningocele is defined as a protrusion of the meninges through an opening in the skull or spinal column, forming a bulge or sac filled with cerebrospinal fluid. A pseudomeningocele is defined as a cerebrospinal fluid (CSF) collection formed due to escape of CSF through a dural defect with trapping of CSF into the surrounding soft tissues. We herby report rare occurrence of a large (pseudo)meningocele in a young patient with congenital skull base defect presenting as upper lateral neck swelling.

CASE PRESENTATION

We present the case of a 17-year-old boy who had painless progressive swelling right side of the upper neck without any history of meningitis or CSF leak. He had a history of undergoing cranioplasty using steel plates for nontraumatic boggy swelling right parieto-occipital region at the age of 5 years at another hospital. Clinical examination showed painless swelling right side of the upper neck, with positive cough impulse and transillumination. CT head with cisternography showed a large right skull base defect through which a large pseudomeningocele was herniating, thus producing upper neck swelling and compressing oral cavity. The neck swelling and intraoral bulge reduced in size after the coperitoneal shunt.

CONCLUSION

Differential diagnosis of (pseudo)meningocele should be considered while evaluating a painless progressive upper neck swelling having cough impulse and transillumination in a young patient.

A review of acute postoperative sialadenitis in children

OBJECTIVE

Acute postoperative sialadenitis is a previously described rare entity that has occurred following general anesthesia and has also been associated with prolonged neurosurgical procedures. We aim to better characterize this entity while performing a literature review regarding potential etiologies, diagnosis, airway management and treatment options.

METHODS

A retrospective chart review was performed at a pediatric tertiary care center from 2000 to 2014. Charts were selected for the study utilizing an ICD-9 diagnosis of sialadenitis occurring within two weeks of a surgical procedure. Data including age, gender, medical history, preoperative diagnosis, operation length, time to symptom onset, and subsequent management were collected. An additional literature review was performed focusing on reports of post-operative acute sialadenitis involving airway compromise.

RESULT

244 charts were reviewed and 4 patients met inclusion criteria. The average time to symptom onset was 4.3 days (range 1 h-12 days) following conclusion of the surgical procedure. Symptoms ranged from mild inflammation of the parotid gland to rapid swelling of the neck necessitating intubation. All patients were treated with standard sialadenitis treatment including hydration, antibiotics, and airway management as needed.

CONCLUSION

To our knowledge this is the first case series reviewing this entity specifically within the pediatric population. There appears to be two distinct categories of postoperative sialadenitis; one of which presents very acutely and results in massive neck swelling and airway compromise. It is important for practicing Otolaryngologists to be aware of this potentially life-threatening complication in the immediate postoperative period.

Nasopharyngeal Carcinoma: A 15 Year Study with Respect to Clinicodemography and Survival Analysis

Nasopharyngeal carcinoma (NPC) is a rare malignancy in Kashmir with distinct pattern, hence we planned to study its clinicodemographic and survival profile. Kashmir has unique lifestyle and dietary habits which may be the source of carcinogenic compounds, most likely implicated in causation of NPC. A total of 148 patients of NPC registered from January 2000 to December 2014 were analyzed. The Mean ± SD age was 45.15 ± 17.092 years (range 11-85 years). The males were 72.3 % (N = 107) with male: female ratio of 2.61:1. Most of the patients were from rural area 81.90 % (N = 95) and non-smokers were 53.44 % (N = 62). Neck swelling was commonest presentation. WHO Type III NPC was commonest histopathological diagnosis 65.3 % (N = 92). Stage IV 36.1 % (N = 51) was commonest stage followed by stage III was 32 % (N = 46). Majority of the patients of NPC received CCRT 68.7 % (N = 78) followed by SCRT 13 % (N = 15) and Induction + CCRT 13 % (N = 15). The overall mean survival of NPC was 49.56 months. There was no significant correlation of age, gender, smoking, histopathology and treatment on the overall survival. However the stage was the only strong predictor of overall survival. Also the patients with intracranial extension had low survival which is turn depicts the advanced stage of disease. NPC survival is directly related to the stage of the disease irrespective of the treatment modality received. The negative EBV status in our patients implies that there are other risk factors involved in the causation of NPC for which further studies are needed to establish the etiological insult.

A case of vascular malformation of the neck

Vascular malformations are rare congenital vascular anomalies composed of inappropriately connected vasculature. They are usually present at birth, are progressive, infiltrative and require intervention. Vascular malformations need to be differentiated from haemangiomas which are congenital vascular neoplasms. We present a case of vascular malformation in a 6-year old child who presented with a progressive swelling in the neck and was treated by surgical excision. This case is being presented because of its peculiar clinical presentation.

Intra-muscular Nodular Fasciitis Presenting as Swelling in Neck: Challenging Entity for Diagnosis

The diagnosis of Nodular Fasciitis is a very challenging on cytological aspirations. Even in histopathological sections, it can be sometimes be mistaken for soft tissue sarcomas due to its high cellularity, presence of mitotic figures, poor circumscription and degenerative myxoid areas. Most commonly, nodular fasciitis is seen on extremities; and sub-cutaneous form is most common. We are hereby reporting a case of nodular fasciitis at a rare site (head and neck area) in its rare form (intra-muscular type: originating within sternocleidomastoid muscle), which was clinically suspected as a malignancy arising from solitary thyroid nodule. Cytological diagnosis was issued as benign spindle cell lesion (where chances of a misdiagnosis as malignant are very high), thereby preventing radical surgery. It was subsequently confirmed as intra-muscular nodular fasciitis after histopathological examination.

Aneurysm of external jugular vein mimicking hemangioma of neck

Venous aneurysms are one of the rare causes of neck swellings. Among neck veins, external jugular vein aneurysms are uncommon. We present a case of a woman who presented with a nontender compressible swelling in the left lower neck region, which initially thought to be hemangioma, was later found to be external jugular vein aneurysm on Doppler ultrasound and CT angiography.

Tracheocele presenting with intermittent dysphonia: a case report

We report a rare case of tracheocele presenting in an ENT setting. The referral was made on the basis of intermittent dysphonia. The aim of this report is to document the rare condition of tracheocele on the right side and to help raise the level of its awareness among the otolaryngologists. So far approximately thirty cases of this condition have been documented in the literature worldwide. An emphasis is placed on the mode of presentation and the management issues, as early diagnosis is crucial and offers a favorable prognosis. The right sided predilection of the swelling is due to anatomical reason and the cause of recurrent dysphonia is explained.

Combined laryngocele secondary to localized laryngeal amyloidosis

Laryngocele is a benign condition due to abnormal dilatation of the laryngeal saccule. Localized amyloidosis causing laryngocele is a rare entity with few reports in the literature. We present a young male patient with a large combined laryngocele secondary to laryngeal amyloidosis.

Intramuscular haemangioma of mylohyoid muscle: A case report

OBJECTIVE

To report a case of intramuscular haemangioma (IMH) with a rare presentation in the mylohyoid, with emphasis on the clinical appearance, and histologic characteristics of the lesion.

METHOD

Case report and review of the literature.

CONCLUSION

Neck swellings can often present a diagnostic dilemma, with a wide preoperative differential diagnosis. IMH are rare benign haemangiomas occurring within the skeletal muscle. They account for approximately 1% of all haemangiomas. These are uncommon in the head and neck region and occur most frequently in the trunk and extremities. In the head and neck, masseter and trapezius are the most common sites involved. Intramuscular haemangioma is seldom diagnosed preoperatively, perhaps due to unfamiliarity with this uncommon lesion and nonspecific clinical findings.