Yadav Mandeep Kumar, Paudel Ashok
Kathmandu Medical College, Sinamangal, Kathmandu, Nepal.
Nepal Bharat Maitri Hospital, Mitrapark, Kathmandu, Nepal.
Ann Med Surg (Lond). 2025 Mar 19;87(5):3002-3005. doi: 10.1097/MS9.0000000000003166. eCollection 2025 May.
Internal jugular vein ectasia (IJVE) is a rare venous anomaly presenting as unilateral neck swelling that is predominantly observed in childhood and infrequently reported in adults. Notably, fewer than 100 cases have been documented worldwide, emphasizing its rarity.This case highlights a 61-year-old Nepalese male with IJVE, notable for its atypical adult onset and right sided presentation.
The patient presented with painless, intermittent swelling that worsened with activities increasing intrathoracic pressure. Clinical examination revealed a soft, pulsatile, fusiform swelling in the right lower neck, well-demarcated along the sternocleidomastoid muscle. The swelling enlarged during the Valsalva maneuver, and ultrasound confirmed IJVE without complications. Given his history of stroke and residual dysphagia, it is important to note that the IJVE's onset appears coincidental rather than causally related.
The exact cause of IJVE remains unclear. Often discovered incidentally, the diagnosis requires differentiation from other neck masses. A detailed history, physical examination, and early use of ultrasound - a low-cost, low risk, and highly accessible imaging modality with high availability and minimal financial burden worldwide - are critical for accurate diagnosis. Conservative management is typically sufficient, with surgery reserved for significant symptoms or cosmetic concerns.
This case underscores the importance of considering IJVE in the differential diagnosis of neck masses, particularly in adults with atypical symptoms. Thorough evaluation and imaging - especially early ultrasound use - play a crucial role in accurate diagnosis and avoiding unnecessary interventions.
颈内静脉扩张（IJVE）是一种罕见的静脉异常，表现为单侧颈部肿胀，主要在儿童期观察到，在成人中鲜有报道。值得注意的是，全球记录在案的病例不到100例，凸显了其罕见性。本病例突出介绍了一名61岁的尼泊尔男性患有IJVE，其非典型的成人发病和右侧表现值得关注。
患者表现为无痛性间歇性肿胀，活动增加胸腔内压力时肿胀加剧。临床检查发现右颈部下方有一个柔软、搏动性、梭形肿胀，沿胸锁乳突肌边界清晰。瓦尔萨尔瓦动作时肿胀增大，超声证实为IJVE且无并发症。鉴于他有中风病史和残留吞咽困难，需要注意的是IJVE的发病似乎是巧合，而非因果关系。
IJVE的确切病因尚不清楚。通常是偶然发现，诊断需要与其他颈部肿块相鉴别。详细的病史、体格检查以及早期使用超声——一种低成本、低风险且易于获得的成像方式，在全球范围内可用性高且经济负担最小——对于准确诊断至关重要。保守治疗通常就足够了，手术仅用于有明显症状或美容需求的情况。
本病例强调了在颈部肿块的鉴别诊断中考虑IJVE的重要性，特别是对于有非典型症状的成年人。全面评估和成像——尤其是早期使用超声——在准确诊断和避免不必要的干预方面起着关键作用。
