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Year : 2002  |  Volume : 12  |  Issue : 3  |  Page : 369-370
Anterior jugular vein aneurysm : Diagnosis by CT angiography


Dept of Radiology, B.J. Medical College and Civil Hospital, Ahmedabad-380 016, Gujarat, India

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Keywords: Venous aneurysm, Anterior Jugular Vein, CT Angiography

How to cite this article:
Desai S J, Rajan S, Jain T. Anterior jugular vein aneurysm : Diagnosis by CT angiography. Indian J Radiol Imaging 2002;12:369-70

How to cite this URL:
Desai S J, Rajan S, Jain T. Anterior jugular vein aneurysm : Diagnosis by CT angiography. Indian J Radiol Imaging [serial online] 2002 [cited 2020 Aug 4];12:369-70. Available from: http://www.ijri.org/text.asp?2002/12/3/369/28486

   Introduction Top


A venous aneurysm is a rare cause of a neck swelling which needs to be considered in the differential diagnosis of neck swellings. Among neck veins, involvement of the Anterior Jugular Vein is uncommon. The diagnosis is suggested by clinical features and can be confirmed by noninvasive radiology. There have been reports of assessment of cervical venous aneurysms by Doppler examination and MR Angiography. We have used CT Angiography to evaluate this lesion.


   Case Report Top


A seven year old female child presented with a two year history of a soft, intermittent, non-tender, non-pulsatile swelling in the midline of the neck that became more prominent during crying and Valsalva maneuver but had no venous hum. There was no history of trauma. Systemic examination was normal.

The case was diagnosed clinically as a laryngocele, but an examination of the neck using Colour Doppler (AU3 Partner; Esaote Biomedica, Florence, Italy) revealed blood flow within the lesion, following which a diagnosis of pseudoaneurysm of a neck vessel was suggested. A Digital Subtraction Angiography study (Philips Medical Systems, Netherlands) performed to delineate the artery of origin of the lesion was unremarkable [Figure - 1]a

Contrast enhanced biphasic helical CT study (Shimadzu SCT 6800TX, Kyudu, Japan) using a caudocranial scanning direction, with collimation of 3mm reconstructed at 1.5 mm intervals with a pitch of 1.5, showed a large fusiform swelling to the left of midline, extending from the suprasternal region into the suprahyoid neck, which enhanced during the venous phase. Duplication of the Anterior Jugular Vein on both sides was noted. The lesion appeared to arise from the left Anterior Jugular Vein (medial branch)[Figure - 1]b. CT Angiography was performed via three dimensional multiplanar reformation using Maximum Intensity Projection, which confirmed the origin of the aneurysm from the left Anterior Jugular Vein [Figure - 1]c.

At surgery, the diagnosis of Anterior Jugular Venous Aneurysm was confirmed. Histopathology revealed elastic tissue dysplasia consistent with a diagnosis of Jugular phlebectasia (venous aneurysm)


   Discussion Top


Venous aneurysm (synonyms: phlebectasia, venous congenital cyst, venous ectasia or essential venous dilatation) refers to an isolated abnormal fusiform or saccular dilatation of a vein. It is an independent nosological unit which differs from varicosities by the following signs: it is not sex or age related; it is also found in children; it can affect any vein; it is found as a solitary lesion and is not associated with prolongation of the affected vein. Most serious complication can be pulmonary embolism [1].

Cervical swelling is a common diagnostic problem in pediatrics, with many etiologies, among which only three enlarge on Valsalva maneuver: 1.Venous Aneurysm 2. Laryngocele 3. Superior Mediastinal tumor.

Venous ectasias or aneurysms in the neck are rare entities, especially in children. In children, the etiology is obscure. No predisposing factors such as antecedent trauma, arterio-venous fistula or associated cardiac anomaly has been found, but in a minority of cases, characteristic histological changes consisting of elastic tissue dysplasia have been demonstrated in the resected aneurysm wall [2].

Phlebectasia may affect any vein in the neck, in the following sequence: Internal Jugular, External Jugular, Anterior Jugular and the Superficial communicans [3]. While the Internal Jugular Vein is the commonest site of a venous aneurysm, recognition that the anterior jugular vein can be affected in isolation may help to avoid diagnostic confusion [4],[5],[6],[7],[8].

Non-invasive diagnosis of jugular phlebectasia can be achieved using ultrasonography combined with Doppler flow imaging, helical CT scanning with contrast, CT Angiography and MR Venography.

No treatment is indicated for this benign self-limiting condition except for the few patients who are symptomatic due to pressure effects or for cosmetic reasons. Treatment is in the form of surgical excision.

 
   References Top

1.Suchy T. Rozhl Chir 1995; 74(6): 284-286  Back to cited text no. 1    
2.Danis RK. Isolated aneurysm of the internal jugular vein: a report of three cases. J Paediatr Surg 1982;17:130-131  Back to cited text no. 2    
3.Gilbert MG, Green berg LA, Brow WT, et al. Fusiform venous aneurysm of the neck in children: a report of four cases. J Paediatr Surg 1972;7:108-111 (Frequency of cases in neck)  Back to cited text no. 3    
4.Bush S, Khan R, Stringer MD. Anterior jugular venous aneurysm. Eur J Pediatr Surg 1999;9(1):47-48  Back to cited text no. 4    
5.Zorn WG, Zorg TT, Van Ballen B. Aneurysm of the anterior jugular vein. J Cardiovasc Surg(Tornio) 1981;22(6):546-549  Back to cited text no. 5    
6.Uzun C, Taslonalp O, Koten M, Adali MK, Karasallhoglu AR, Pekindil G. Phlebectasia of left anterior jugular vein. J Laryngol Otol 1999; 113(9):858-860  Back to cited text no. 6    
7.Natarajan B, Johnstone A, Sheikh S, Palmer O, Madhavan KN.Unilateral anterior jugular phlebectasia. J Laryngol Otol 1994; 108(4): 352-353  Back to cited text no. 7    
8.Kato M, Shimizu H, Ole M, Uchiyama M, Ohlake K. Aneurysm of the anterior jugular vein in a child - a case report. Rinsho Hoshasen 1983; 28(4): 475-477  Back to cited text no. 8    

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Correspondence Address:
S J Desai
Dept of Radiology, B.J. Medical College and Civil Hospital, Ahmedabad-380 016, Gujarat
India
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Source of Support: None, Conflict of Interest: None


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    Figures

[Figure - 1]

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    Introduction
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