1* Jugular phlebectasia in children: is it rare or ignored?
Author :Sander S; Eliçevik M; Unal M; Vural O
SSK Bakirkoy Maternity and Children's Hospital, Department of Pediatric Surgery, Istanbul, Turkey.
Source : J Pediatr Surg, 1999 Dec, 34:12, 1829-32
Abstract: BACKGROUND/PURPOSE: Phlebectasia of the jugular veins is a venous anomaly that usually presents in children as a soft cystic swelling in the neck during straining. The purpose of this report is to discuss the differential diagnosis, the methods of imaging, the mode of treatment, and to demonstrate some factors that have made us believe that the condition may not be an actual rarity but rather has been ignored. METHODS: Eight cases of unilateral internal jugular phlebectasia were treated surgically (ie, excision of the dilated portion of the vein) from 1987 to 1998. The age of the patients ranged from 3 to 14 years. There were 3 girls and 5 boys. The lesions were right sided in 6, and left sided in 2 children. The patients underwent surgery after comparative ultrasonographic confirmation of the diagnosis. Furthermore, the authors prepared a simple questionnaire for evaluating the level of knowledge about this lesion among the related specialists. One hundred ten physicians were asked to describe the jugular phlebectasia and its ideal treatment. RESULTS: All of the patients were discharged from the hospital 24 hours after surgery. Follow-up periods ranged from 6 months to 6 years and no complaints were noted at the time of most recent visits. Our questionnaire results showed that 96% of 73 pediatricians, 37% of 22 otorhinolaryngologists, and 40% of 15 pediatric surgeons did not know what the jugular phlebectasia was. CONCLUSIONS: Color Doppler sonography alone is sufficient for the diagnosis of jugular phlebectasia. The authors recommend surgical excision in asymptomatic cases for cosmetic and psychological purposes. The rarity of the lesion may be caused by a lack of knowledge among the related physicians and the tendency of reporting only surgical results.

2*:Internal jugular phlebectasia. A clinicoroentgenographic diagnosis.
Author :LaMonte SJ; Walker EA; Moran WB
Source :Arch Otolaryngol, 1976 Nov, 102:11, 706-8
Abstract : The most common cause of a mass in the neck that appears only on straining is a laryngocele. However, internal jugular phlebectasia may manifest in a similar manner. Dilation of the internal jugular vein with any maneuver that increases intrathoracic pressure suggests mechanical obstruction in the neck or the mediastinum, but the cause is still in doubt. Dilated internal jugular veins have been excised and have been found to have thinning of the wall of the vein, but have not been found to have a congenital abnormality.

3* [Duplex Doppler ultrasound of internal jugular vein ectasia. Case report]
Author :Lin MJ; Chou YH; Tiu CM; Yeh TJ; Wei JF; Chang T
Department of Radiology, Veterans General Hospital-Taipei, R.O.C.
Source :Chung Hua I Hsueh Tsa Chih (Taipei), 1990 Sep, 46:3, 190-3
Abstract : A seven-year-old boy, who complained of painless swelling mass over the right neck on exertion, was diagnosed as right internal jugular vein ectasis by the duplex Doppler ultrasound. The caliber of the right internal jugular vein was prominently dilated when Valsalva maneuver was done, the duplex Doppler ultrasound showed an essentially flat wave from that indicated the swelling mass to be a venous structure. The clinical manifestation, etiology, pathological findings and diagnostic methods of the internal jugular vein ectasia were reviewed with emphasis on the advantages of duplex Doppler ultrasound in confirming the diagnosis.
Language of Publication :Chinese

4*Title :Internal jugular phlebectasia.
Author :Kuo WR; Chien CC; Chai CY; Huang HR; Jan YS; Huang YC; Juan KH
Departmant of Pathology, Kaohsiung Medical College, Taiwan, Republic of China.
Source :Kao Hsiung I Hsueh Ko Hsueh Tsa Chih, 1992 Sep, 8:9, 503-9
Abstract :Phlebectasia, defined as abnormal venous dilation, may occur in a number of different sites. Two cases with definite diagnosis of internal jugular phlebectasia were reported. The first case was a 6-year-old girl with a bulging mass on right neck for 3 years. Angiography and CT scan showed definite diagnosis, and the bulging mass was resected from the internal jugular vein (IJV). The second case was a 66-year-old female patient, also complained of a bulging mass on her right neck. Sonogram and CT scan also showed the same diagnosis. Because it did not bother the patient, she was just under close observation. From the three kinds of diagnostic modalities, we found sonography is an effective technique because of its clarity, safety and low cost.

5* Unusual neck masses secondary to jugular venous abnormalities: case report and discussion.
Author :Stocks RM; Milburn M; Thompson J
Department of Otolaryngology, Head and Neck Surgery, The University of Tennessee-Memphis, USA.
Source :Am Surg, 1997 Apr, 63:4, 305-9
Abstract : Thrombosis of the lateral sinus/proximal jugular vein and jugular venous ectasia are infrequent but not uncommon neck masses. Lateral sinus thrombosis was well described in the preantibiotic era, but modern-day surgeons may not be familiar with this entity. Failure to diagnose a neck mass due to jugular vein thrombosis may have deadly consequences. Jugular vein ectasia, which is innocuous, has been mistaken for laryngocele, cystic hygroma, as well as other vascular lesions. However, the management of jugular vein ectasia, which is thought to be caused by incompetence of the bicuspid jugular venous valve, is conservative. We present a case illustrating a neck mass arising from the internal jugular vein with a discussion of jugular venous pathology.

6*Internal jugular phlebectasia.
Author : al Dousary S
Address: Otolaryngology Department, King Abdulaziz University Hospital, Riyadh, Saudi Arabia.
Source : Int J Pediatr Otorhinolaryngol, 1997 Jan, 38:3, 273-80
Abstract : BACKGROUND: Anterior neck mass which appears on straining should be differentiated from laryngocele, jugular venous system phlebectasia and superior mediastinal cysts or masses. Internal jugular phlebectasia is a fusiform dilatation of the internal jugular vein. PURPOSE: this is an attempt to elucidate the etiology, clinical features, diagnosis, treatment and review of the literature about this rare venous lesion. METHODS: an 11 year old boy presented with soft neck swelling on the right side which appeared on straining. The diagnosis was confirmed on the bases of ultrasonography combined with Doppler flow imaging and spiral computerized tomography scan with contrast. The patient was treated conservatively and followed up for 21 months without any changes. CONCLUSION: internal jugular phlebectasia is a rare disease, which mostly involves the right side. It is usually a childhood disease and believed to be of congenital origin. It can occur at any age and affects both genders. Nevertheless no single case was reported in a young adult male. The diagnosis was made on a clinical basis and confirmed by less invasive radiologic technique. The investigations of choice are Doppler ultrasonography and spiral computerized tomography scan with contrast. Even though most of these lesions have been excised surgically, the treatment of choice should be conservative as long as it is asymptomatic.

7*Congenital internal jugular venous aneurysm: diagnosis and treatment.
Author : Bosshardt TL; Honig MP
Address :Department of Surgery, Naval Hospital Oakland, CA 94627-5000, USA.
Source : Mil Med, 1996 Apr, 161:4, 246-7
Abstract : The diagnosis, preoperative work-up, and treatment of a neck mass can be extensive and complex. We report a case of an adolescent female who presented with a soft compressible mass in her neck that became more prominent during phonation (singing). Dynamic magnetic resonance imaging (MRI) confirmed this mass to be an isolated dilation of the internal jugular vein. The patient subsequently underwent an uncomplicated cosmetic excision of a large venous aneurysm. We recommend dynamic MRI as a useful noninvasive exam in the preoperative evaluation of this rare entity.

8*Unilateral anterior jugular phlebectasia.
Author :Natarajan B; Johnstone A; Sheikh S; Palmer O; Madhavan KN
Source :J Laryngol Otol, 1994 Apr, 108:4, 352-3
Abstract : We present a rare case of unilateral anterior jugular venous phlebectasia in an 82-year-old female patient presenting as a soft cystic lump in the anterior aspect of the neck increasing in size during straining and valsalva manoeuvre. Although cases of internal and external jugular phlebectasia have been reported, as far as we are aware no case of anterior jugular phlebectasia has been reported in the literature previously.

9*Title :Internal jugular vein phlebectasia and duplication: CT features.
Author : Som PM; Shugar JM; Sacher M; Lanzieri CF
Source : J Comput Assist Tomogr, 1985 Mar, 9:2, 390-2
Abstract : Phlebectasia of the internal jugular vein (IJV) is a rare entity with only 25 cases having been reported. Clinically this condition presents with enlargement with a Valsalva maneuver and decrease at rest. Venography, anteriography, and ultrasound have previously been used to diagnose this unusual cause of neck mass. We present a case in which CT confirmed the clinical diagnosis and in which there was an incomplete ipsilateral duplication of the IJV. This is only the second case reported of IJV phlebectasia and duplication.

10*Jugular phlebectasia in children.
Author :Balik E; Erdener A; Taneli C; Mevsim A; Sayan A; Yüce G
Department of Pediatric Surgery, Ege University Faculty of Medicine, Bornova, Izmir, Turkey.
Source : Eur J Pediatr Surg, 1993 Feb, 3:1, 46-7
Abstract : Jugular phlebectasia is a congenital dilatation of jugular vein which appears as a soft, compressible mass in the neck only during straining or crying. It should be differentiated from laryngocele, cysts and tumors of neck which may also appear during straining. Comparable ultrasonography (US) and computerized tomography (CT) are diagnostic methods to distinguish the pathology. Four children with jugular phlebectasia diagnosed by venography, US and CT are reported. Surgical excision of the dilated segment was performed in each case. The inevitability of surgical intervention is discussed.

11*Jugular phlebectasia.
Author : Nwako FA; Agugua NE; Udeh CA; Osuorji RI
Department of Pediatric Surgery, University of Nigeria Teaching Hospital, Enugu, Anambra State, Nigeria.
Source :J Pediatr Surg, 1989 Mar, 24:3, 303-5
Abstract : The most common cause of a mass in the neck that appears only during straining is a laryngocele. However, the rare jugular phlebectasia may present in a similar manner. Dilatation of the internal jugular vein with a Valsalva maneuver suggests a mechanical obstruction in the neck or mediastinum, but the exact cause is still unknown. Nevertheless, dilated internal jugular veins have been excised, as in the case reported here, and found to have thinning of the wall but no associated abnormality.

12*Title :External jugular phlebectasia in children [see comments]
Author :Pul N; Pul M
Department of Paediatrics of State Hospital, Edirne, Turkey.
Source : Eur J Pediatr, 1995 Apr, 154:4, 275-6
Abstract : The most common cause of a mass in the neck appearing only during straining is a laryngocele. On the other hand, the rare jugular phlebectasia may present in a similar manner. The cause of the jugular phlebectasia remains unclear. No treatment is indicated for this benign self-limiting condition. However, surgical removal for cosmetic purposes alone consists of a unilateral excision of the internal or external jugular vein; this produces no gross side-effects. Conclusion. Every patient with a swelling in the neck that enlarges in size after the Valsalva manoeuvre, straining, coughing or sneezing should be suspected of having jugular phlebectasia.

13*Usefulness of ultrasonography and Doppler color flow imaging in the diagnosis of internal jugular phlebectasia.
Author : Shimizu M; Takagi Y; Yoshio H; Takeda R; Matsui O
Second Department of Internal Medicine, School of Medicine, Kanazawa University, Japan.
Source : Heart Vessels, 1992, 7:2, 95-8
Abstract : A 20-year-old woman presented to our hospital for investigation of a left neck mass. Ultrasonographic examination of the jugular mass demonstrated an echo-free space, the caliber of which markedly increased when the patient shifted from the sitting to the recumbent position or performed a Valsalva maneuver. On color Doppler flow imaging, a slow flow signal flowing in the direction opposite to that of the common carotid artery was found within this space. Ultrasonography and color Doppler flow imaging thus proved to be useful for correctly diagnosing internal jugular phlebectasia.

14*[Jugular phlebectasia: a report of two cases]
Author : Grijalba Uche M; Trelles Vargas H; Echeverría Zabalza ME; Medina Sola JJ
Servicio de OtorrinolaringologÆia, Hospital Virgen del Camino, Pamplona.
Source :An Otorrinolaringol Ibero Am, 1996, 23:3, 235-41
Abstract : We report 2 cases of internal jugular phlebectasia addressed to our ENT-Department for investigation. The sole clinical symptomatology was a latero-cervical right mass expanding with Valsalva's manoeuvre. We make an actualization of the theme's literature and recommend the echography as a method of choice for diagnose, being that technique non-invasive, quick and reproduceable.
Language of Publication Spanish

15* Internal jugular phlebectasia.
Author : Matsuba HM; Thawley SE; Smith PG
Deparment of Otolaryngology, Washington University School of Medicine, St. Louis, MO.
Source :Head Neck Surg, 1985 May, 7:5, 431-3
Abstract : Internal jugular phlebectasia or abnormal fusiform dilatation of the jugular venous system usually presents as a neck mass that increases in size with maneuvers, which increase intrathoracic pressure. We present a case of internal jugular phlebectasia in which, due to an atypical presentation, the diagnosis was confirmed only by surgical exploration. The pathophysiology and radiologic evaluation are discussed to determine the role reserved for surgery in the management of this entity.

16* [Aneurysms of the external jugular vein]
Author :Porcellini M; Selvetella L; Bernardo B; Del Guercio L; Baldassarre M
UniversitÄa degli Studi Federico II Napoli Cattedra di Chirurgia Vascolare.
Source : G Chir, 1996 May, 17:5, 238-41
Abstract : External jugular vein aneurysms are rare and appear as a soft, compressible mass in the neck. Three cases are herein reported. Ultrasonography is the investigation of choice. Surgical excision is indicated, specially in case of giant and thrombosed venous aneurysm.
Language of Publication : Italian

17*Internal jugular phlebectasis. A clinicoroentgenographic diagnosis.
Author :LaMonte SJ; Walker EA; Moran WB
Source :Arch Otolaryngol, 1976 Nov, 102:11, 706-8
Abstract : The most common cause of a mass in the neck that appears only on straining is a laryngocete. However, internal jugular phlebectasia may manifest in a similar manner. Dilation of the internal jugular vein with any maneuver that increases intrathoracic pressure suggests mechanical obstruction in the neck or the mediastinum, but the cause is still in doubt. Dilated internal jugular veins have been excised and have been found to have thinning of the wall of the vein, but have not been found to have a congenital abnormality.

18*:Internal jugular phlebectasia in children.
Author :Yashiro N; Iio M
Source : Radiat Med, 1984 Apr, 2:2, 136-9
Abstract :Two pediatric cases with internal jugular phlebectasia which showed specific clinical and radiographic features are described. CT and venography were useful in the diagnosis. Differential diagnosis of cervical masses which enlarge with Valsalva maneuver are also discussed with a review of the literature.

19*Internal jugular phlebectasia in two siblings: manometric and histopathologic studies of the pathogenesis.
Author :Yokomori K; Kubo K; Kanamori Y; Takemura T; Yamamoto T
Department of Pediatric Surgery, Japanese Red Cross Medical Center, Tokyo.
Source : J Pediatr Surg, 1990 Jul, 25:7, 762-5
Abstract : Two brothers, 4 years and 6 years of age, presented with a swelling in the right side of the neck. Ultrasonography and venography confirmed a diagnosis of phlebectasia of the right internal jugular vein (IJV). In an attempt to elucidate the etiology of this rare lesion, venous pressures in both the dilated right IJV and in the left IJV were taken under general anesthesia with intratracheal intubation at the time of surgery in each patient. No significant difference in pressure elevation with increase of intrathoracic pressure by overinflating the breathing bag was observed between the right and left IJV, suggesting that there would be no mechanical obstructive process generated on exertion, in each case. Microscopic examinations of a dissected portion of the dilated IJV showed paucity of muscle layer of the vein wall in the younger patient, and absence of that in the elder. Therefore, we assume that congenital muscle defect of the right IJV wall, rather than mechanical obstruction in the lower neck or the mediastinum, might cause phlebectasia. To our knowledge, this is the first report of IJV phlebectasia in siblings.

20*Usefulness of ultrasonography and Doppler color flow imaging in the diagnosis of internal jugular phlebectasia.
Author : Shimizu M; Takagi Y; Yoshio H; Takeda R; Matsui O
Second Department of Internal Medicine, School of Medicine, Kanazawa University, Japan.
Source : Heart Vessels, 1992, 7:2, 95-8
Abstract :A 20-year-old woman presented to our hospital for investigation of a left neck mass. Ultrasonographic examination of the jugular mass demonstrated an echo-free space, the caliber of which markedly increased when the patient shifted from the sitting to the recumbent position or performed a Valsalva maneuver. On color Doppler flow imaging, a slow flow signal flowing in the direction opposite to that of the common carotid artery was found within this space. Ultrasonography and color Doppler flow imaging thus proved to be useful for correctly diagnosing internal jugular phlebectasia.

21*Title :Bilateral internal jugular phlebectasia.
Author :Walsh RM; Murty GE; Bradley PJ
ENT Department, University Hospital, Queen's Medical Centre, Nottingham.
Source :J Laryngol Otol, 1992 Aug, 106:8, 753-4
Abstract : Internal jugular phlebectasia is a venous anomaly commonly presenting as a unilateral neck swelling in children. The clinicopathology, aetiology and management are discussed. Bilateral doppler ultrasonography is the diagnostic investigation of choice and should be performed in all suspected cases. Conservative management of the bilateral case is recommended

22* Bilateral internal jugular phlebectasia.
Author : Walsh RM; Murty GE; Bradley PJ
ENT Department, University Hospital, Queen's Medical Centre, Nottingham.
Source : J Laryngol Otol, 1992 Aug, 106:8, 753-4
Abstract :Internal jugular phlebectasia is a venous anomaly commonly presenting as a unilateral neck swelling in children. The clinicopathology, aetiology and management are discussed. Bilateral doppler ultrasonography is the diagnostic investigation of choice and should be performed in all suspected cases. Conservative management of the bilateral case is recommended

23*Bilateral internal jugular phlebectasia.
Author : Walsh RM; Murty GE; Bradley PJ
ENT Department, University Hospital, Queen's Medical Centre, Nottingham.
Source : J Laryngol Otol, 1992 Aug, 106:8, 753-4
Abstract : Internal jugular phlebectasia is a venous anomaly commonly presenting as a unilateral neck swelling in children. The clinicopathology, aetiology and management are discussed. Bilateral doppler ultrasonography is the diagnostic investigation of choice and should be performed in all suspected cases. Conservative management of the bilateral case is recommended

24*Jugular phlebectasia.
Author : Gürpinar A; Kiristioglu I; Dogruyol H
Uludag University, Medical Faculty, Department of Pediatric Surgery, Bursa, Turkey.
Source : Eur J Pediatr Surg, 1999 Jun, 9:3, 182-3
Abstract : A patient, 5 years of age, presented with a swelling on the right side of the neck. Ultrasonography and computed tomography confirmed a diagnosis of phlebectasia of the right internal jugular vein (IJV). The patient underwent operation and the dilated IJV was excised. Dilatation of the IJV with a Valsalva maneuver suggested a mechanical obstruction in the neck or mediastinum. However, the exact cause is still unknown. Finally, we found the patient to have a thinning of the wall but no other associated abnormality.

25*Angiographic diagnosis of jugular venous system dilatation in children. A report of five cases.
Author : Passariello R; Cozzi F; Casalena G; Colarossi G; Rossi P; Simonetti G
Source : Pediatr Radiol, 1979 Oct, 8:4, 247-50
Abstract : We report five children with a soft mass in the neck due to congenital jugular venous ectasia. Three had fusiform dilatation of the internal jugular vein, which in one case was associated with dilatation of the ipselateral external jugular vein. Two children had aneurysmal dilatation of the superficial cervical communicating vein. The first four cases required angiographic studies for final diagnosis. Venography via the femoral vein was most valuable for visualization of the dilated segments of internal jugular veins but failed to show the vascular mass communicating with the superficial vein of the neck. These were best visualized by direct injection of the contrast medium into the vessel. In the fifth case a correct diagnosis was obtained with xeroradiography alone.

26*Internal jugular phlebectasia--an unusual cause of neck swelling.
Author :Indudharan R; Quah BS; Shuaib IL
Department of Otorhinolaryngology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia. [email protected]
Source : Ann Trop Paediatr, 1999 Mar, 19:1, 105-8
Abstract :We describe a 7-year-old child who presented with a soft fluctuant swelling on the neck which became more prominent during the Valsalva manoeuvre. He underwent adeno-tonsillectomy based on a mistaken diagnosis of ballooning of the pharynx secondary to enlarged adenoids and tonsils obstructing the nasopharyngeal and oropharyngeal airways. Investigations revealed the swelling to be a markedly dilated internal jugular vein. We discuss the diagnostic features and mode of treatment of this condition so as to avoid unnecessary and dangerous surgical intervention.

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