External jugular venous aneurysm: A clinical curiosity
We report a case of a 12-year-old boy presented with a painless swelling on the right side of the neck for 6 months. The swelling became more prominent on breath holding [] and decreased in size on resuming normal breathing. There was no prior history of trauma or any chronic illness. Upon examination, a 4.0 × 4.0 cm swelling appeared on the right supraclavicular area lateral to the clavicular head of the sternomastoid muscle on breath holding. The swelling was non-tender, soft and compressible, and had ill-defined margins. Visible pulsation or cough impulse was absent. However, the swelling did not become prominent on Valsalva maneuver when pressure was applied to an external jugular vein (EJV) above the swelling. No bruit was audible on auscultation. Chest X-ray was normal. Ultrasound revealed an anechoic lesion measuring 3.4 × 3.3 × 3.0 cm adjacent to and communicating with EJV, approximately 1.3 cm proximal to its merger with the subclavian vein []. Color Doppler examination demonstrated slow flow within this lesion. On computerized tomogram (CT) angiography, a 3.4 × 3.3 × 3.0 cm enhancing lesion was seen superior to the right subclavian vein causing splaying of EJV and internal jugular vein []. Intra-operatively, the vascular lesion was found to be originating from the right EJV. The aneurysm was excised after ligation of various tributaries. Recovery was uneventful and the child was discharged on the fourth postoperative day.