Velayutham Jeeven, Narayanan Dakshaini
Department of Otorhinolaryngology, Hospital Tuanku Ampuan Najihah, Kuala Pilah, Negeri Sembilan Malaysia.
Indian J Otolaryngol Head Neck Surg. 2022 Oct;74(Suppl 2):2620-2622. doi: 10.1007/s12070-020-02324-8. Epub 2021 Jan 7.
Phlebectasia is the abnormal saccular fusiform dilatation (without tortuosity) of a vein, which may affect any vein. Its etiology remains unknown and it is seen usually in the pediatric age group as a unilateral lower neck swelling, mostly on the right side. The other differential diagnoses of the neck swellings which increase in size during a Valsalva manoeuver are tumors or cysts of the upper mediastinum, external laryngeal diverticulum or laryngoceles. Our case report has highlighted the importance of understanding the nature of this lesion by using non-invasive radiological diagnostic modalities (USG), in order to avoid invasive investigations which can lead to catastrophic results. Case report. We describe a case of five year old boy with history of inguinal hernia repair a year ago presented with intermittent right sided neck swelling since he was two years old. His examination at rest was normal. However, with the Valsalva manoeuver a soft, painless, compressible swelling which appeared in the right lower neck was seen, which was not attached to the deep structures. Flexible nasopharyngolaryngoscope revealed normal laryngeal finding. Initial ultrasound finding revealed normal looking cervical lymph nodes bilaterally with no suspicious cystic lesion or collection. Patient then arranged for MRI neck where there are multiple bilateral subcentimeter cervical lymph nodes. However, repeated ultrasound neck while performing Valsalva manoeuver by patient showed sonographic features in keeping with bilateral internal jugular veins phlebectasia. Patient then was referred to pediatric surgeon for further management. A clinical diagnosis can be achieved by having a strong suspicion about this intermittent neck mass. It should be evaluated with non-invasive radiological modalities to avoid the possible catastrophic results which result from invasive techniques.
静脉扩张是指静脉的异常囊状梭形扩张（无迂曲），可累及任何静脉。其病因尚不清楚，通常在儿童年龄组中表现为单侧下颈部肿胀，多见于右侧。瓦尔萨尔瓦动作时增大的颈部肿胀的其他鉴别诊断包括上纵隔肿瘤或囊肿、喉外憩室或喉膨出。我们的病例报告强调了通过使用非侵入性放射诊断方法（超声）来了解这种病变性质的重要性，以避免可能导致灾难性后果的侵入性检查。病例报告。我们描述了一名5岁男孩的病例，该男孩一年前有腹股沟疝修补史，自两岁起出现间歇性右侧颈部肿胀。他静息时检查正常。然而，在瓦尔萨尔瓦动作时，可见右颈部下方出现一个柔软、无痛、可压缩的肿胀，与深部结构不相连。可弯曲鼻咽喉镜检查显示喉部正常。最初的超声检查发现双侧颈部淋巴结外观正常，无可疑囊性病变或积液。患者随后安排了颈部MRI检查，发现双侧有多个小于1厘米的颈部淋巴结。然而，患者在进行瓦尔萨尔瓦动作时重复进行颈部超声检查，显示超声特征符合双侧颈内静脉扩张。患者随后被转诊至小儿外科医生处进行进一步治疗。通过对这种间歇性颈部肿块有强烈怀疑可以做出临床诊断。应使用非侵入性放射学方法进行评估，以避免侵入性技术可能导致的灾难性后果。
