Phlebectasia of internal jugular vein

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.

Internal jugular phlebectasia in pediatric patients: a report of two Saudi cases

Phlebectasia is a rare condition that refers to the dilatation of any vein in the neck. It is more common in the internal jugular vein and in boys. Diagnosis of the condition is based on ultrasound with Doppler and contrast-enhanced computed tomography. Management of this condition is conservative unless there are complications that may require surgery. Here, we present two pediatric cases of internal jugular phlebectasia. The first patient was an 8-year-old boy, and the second was a 5-year-old boy. They both presented to our clinic with recurrent tonsillitis for tonsillectomy, and both were incidental findings.

Comprehensive review with pooled analysis on external and internal jugular vein aneurysm

OBJECTIVE

The aim of the present comprehensive review was to present an overview of the clinical presentation and treatment options for external (EJVAs) and internal jugular vein aneurysms (IJVAs) to help clinicians in evidence-based decision making.

METHODS

A systematic literature search was conducted in accordance with the PRISMA (preferred reporting items for systematic reviews and meta-analyses) statement and included MEDLINE, Embase, Cochrane Library, Scopus, WHO (World Health Organization) trial register, ClinicalTrials.gov, and the LIVIVO search portal. The inclusion criteria were studies of patients who had presented with IJVAs or EJVAs. The exclusion criteria were animal and cadaver studies and reports on interventions using the healthy jugular vein for access only (ie, catheterization). Analysis of the pooled data from all eligible case reports was performed.

RESULTS

From 1840 identified reports, 196 studies were eligible. A total of 256 patients with JVAs were reported, with 183 IJVAs and 73 EJVAs. IJVAs were reported to occur in 66% on the right side compared with the left side (P = .011). The patients with IJVAs were mostly children (median age, 12 years; interquartile range, 5.8-45.2 years). The patients with EJVAs were young adults (median age, 30 years; interquartile range, 11.0-46.5 years). EJVAs were more frequently reported in women and IJVAs in men (P = .008). Most of the patients were asymptomatic. Pulmonary embolization in association with thrombosed EJVAs was only reported for one patient. A report of the outcomes after surgery and conservative management was missing for ∼50% of the patients. No relevant complications were reported after ligation of the EJVA without reconstruction. Intracranial hypertension after ligation of the right-sided IJVA was reported in three children; in one of them, a pontine infarction was observed.

CONCLUSIONS

JVAs are a disease of the younger population but can occur at any age. It seems to be safe to observe patients with nonthrombosed JVAs. However, in the presence of thrombus or pulmonary embolization, surgical treatment should be considered. A reconstruction technique of the IJVA with venous patency preservation should be preferred.

[Painful cervical mass revealing an aneurysm of the internal jugular vein]

Internal jugular vein aneurysms or phlebectasia of the internal jugular vein are considered a benign pathology. They are more and more diagnosed with the evolution of imaging techniques : ultrasonography, angioscanner and MRI. Clinically they are often by chance, however accompanying clinical signs can be seen such as pain, hoarseness or vocal cord paralysis. Several differential diagnoses can be mentioned such as laryngocoele, gill cyst, paraganglioma and hemangioma. They are of unknown etiology with several hypotheses on the etiopathogenesis and on the frequent localization on the right. Conservative treatment can be chosen for small aneurysms and in children. Surgical treatment finds its indication especially in the event of a complication such as thrombosis or for an aesthetic interest; other treatments such as endovascular treatment are being evaluated. We report the case of a 67-year-old woman admitted for a painful latero-cervical mass, and in whom the diagnosis of an aneurysm of the internal jugular vein was suspected and confirmed by ultrasound and CTscan. The patient received successful surgical treatment.

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.

The louder the bigger: A case of jugular phlebectasia in a child

Jugular phlebectasia has been increasingly recognised with the advent of non-invasive diagnostic methods. Phlebectasia differs from varix, as it is an abnormal outward dilatation of a vein without tortuosity. It presents as a soft, compressible mass, apparent upon straining or execution of the Valsalva maneuver. The differentials for neck masses are broad, but if the swelling appears on the Valsalva maneuver, the type of mass narrows down to a laryngocele, superior mediastinal mass or phlebectasia. A simple non-invasive investigation, such as ultrasonography, is used as a diagnostic tool. We report a case of jugular phlebectasia that was suspected clinically and confirmed via ultrasound to be a vascular lesion which changed its size upon straining.

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.

Unilateral internal jugular vein phlebectasia in an adult: Management and one year follow-up

Phlebectasia describes an anomalous, fusiform dilatation of a vein. In the neck region, the internal and external jugular veins are mostly affected. To our knowledge, this is the first case in Saudi Arabia of internal jugular phlebectasia affecting an adult female. We describe a 61-year-old female with complaints of a neck swelling she noticed 4 years ago. Initially, the swelling increased in size and reached a stable level. It was asymptomatic and only enlarged during Valsalva maneuver. Flexible nasolaryngoscopy and computerized tomography scan showed unremarkable examination. Follow-up after 1 year with US Doppler showed no progression. Internal jugular phlebectasia is a rare disorder which is often diagnosed during childhood. More often than not, it does not cause any significant morbidity. Since it is a benign condition, observation is advised with regular monitoring. For asymptomatic lesions, surgical intervention is recommended if cosmetic or psychologic concerns are present.

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.

Right Internal Jugular Vein Phlebectasia: A Rare Cause of Neck Swelling

Internal jugular vein (IJV) phlebectasia is a rare condition presenting as a self-reducible soft tissue swelling of the neck due to fusiform dilation of the venous wall. We report the case of a 7-year-old boy who presented with painless soft mass in the side of the neck which appears during coughing and straining and reduces spontaneously. Diagnosis was confirmed by Doppler ultrasonography and magnetic resonance imaging of the neck. Conservative management and regular follow-up were considered. In this case report, we highlight this rare benign condition as an uncommon differential of neck swellings in order to avoid unnecessary diagnostic workup and interventions.