Phlebectasia of Internal Jugular Vein
A 12-year-old boy presented to us with history of a swelling appearing only on the right side of the neck on straining and coughing for the last 6 months. Swelling was gradual in onset and slowly progressive in nature. It was not associated with any other features like pain, change of voice, facial congestion, and difficulty in swallowing or breathing. On clinical examination, there was a soft cystic swelling over lower one-third of right side of the neck, apparent only on straining, coughing, or performing Valsalva maneuver, being completely undetected otherwise []. Local temperature was not raised, the swelling was nontender, and it was not possible to get below the swelling. There was no lymphadenopathy, pulsation, or bruit. General examination was normal otherwise. X-ray neck revealed no widening or air at the region of the mass, thus excluding laryngocele. Color Doppler was done which revealed internal jugular vein dilatation upon Valsalva maneuver and confirmed the diagnosis of IJP. Since the swelling had increased to a noticeable size upon minimal exertion, which made his parents worried, decision of surgery was made. Exploration and wrapping the dilated segment in an 8-mm-diameter PTFE tube graft was planned. Under general anesthesia, an oblique incision over the anterior margin of the right sternocleidomastoid was made and the whole of the internal jugular vein was dissected out of the carotid sheath from its origin at the base of the skull to its drainage in subclavian vein []. The tributaries of the internal jugular vein were ligated and divided; the PTFE graft was cut open longitudinally and wrapped around the vein in its entire extent. Head high position was given causing the vein to collapse and the cut edges of the graft were sutured to each other using 4-0 silk sutures on an atraumatic needle []. Care was taken to prevent inadvertent damage to the jugular vein or the contents of the carotid sheath. This reinforcement prevented the vein from dilating and at the same time preserved its function.\nPostoperative period was uneventful; there were no surgical site complications. Color Doppler done after 2 weeks of surgery showed patency of the vascular channel with no evidence of thrombus. Six months postoperatively, the patient is asymptomatic.