Image Diagnosis: Classic External Jugular Vein Aneurysm

CASE PRESENTATION A 43-year-old man presented with 9 months of swelling over the left lateral aspect of the neck, which had progressively increased in size (Figure 1) and was associated with mild, intermittent discomfort. On physical examination, there was a 5-cm x 6-cm oval, nonpulsatile, compressible area of swelling in the left posterior triangle of the neck, which increased in size on straining, coughing, and Valsalva maneuver. There was no bruit or venous hum on auscultation. Results of ultrasonography of the neck revealed an outpouching (aneurysm) of 54 mm x 24 mm from the left external jugular vein (EJV). Results of computerized tomographic venography showed a left EJV aneurysm (56 x 27 x 46 mm) (Figure 2) along the lateral aspect of the neck, with dependent layering thrombus within the aneurysm. The patient wanted treatment because of the increase in size and mild discomfort associated with it. Under local anesthesia, ligation of the proximal and distal EJV was performed, and the aneurysm was excised. The postoperative period was uneventful, and the patient was discharged on the same day. He was asymptomatic, with no swelling in the neck at 3-month follow-up. Postoperative ultrasonography assessment confirmed no residual or recurrent venous aneurysm.