Saccular Aneurysm of External Jugular Vein Presenting as a Fluctuating Mass in Neck

Introduction

The natural course of venous aneurysms, which are rarer than the arterial system, varies according to the anatomical location. ¹ Those located in the head and neck region, unlike other regions, show a better clinical course such as pain, tenderness, and swelling. ² Venous aneurysms in the neck region are seen in the internal jugular vein, external jugular vein, and less frequently in the anterior jugular vein. Although fusiform cervical venous aneurysms are common, saccular aneurysms of the external jugular veins are extremely rare; few true cases of venous saccular aneurysms unrelated to previous medical intervention have been reported in the English literature. Doppler ultrasonography (US), computed tomography angiography, and magnetic resonance (MR) angiography allow accurate diagnosis of venous aneurysms.^3,4 Here, we present the MR angiography findings of a 50-year-old patient with saccular aneurysm of the external jugular vein mimicking a left neck mass.

Case Presentation

A 50-year-old female patient was admitted to our department with the complaint of a long-standing painless mass in the left neck region. The patient had no history of trauma or medical intervention to this area. Physical examination revealed a soft, compressible, nontender, and fluctuating swelling in this localization. There was no findings such as redness or temperature increase in the skin covering the swelling. The mass was found to enlarge slightly with the Valsalva maneuver. No palpable mass was detected in other parts of the neck. Blood tests were unremarkable. US examination revealed a compressible anechoic mass. MR imaging and MR angiography demonstrated a saccular aneurysm in the left external jugular vein (Figure 1A to C). No complications such as embolism or rupture were detected.

Figure 1.

Axial post-contrast T1 weighted MR imaging (A), post-contrast dynamic sagittal MR venography (B) and three dimensional volume rendering coronal plane MR venography (C) demonstrate a saccular aneurysm (star) in the left external jugular vein (LEJV).

Conclusion

Venous aneurysms can be classified as congenital and acquired. Congenital venous aneurysms are usually fusiform and are often diagnosed in childhood. Acquired saccular aneurysms develop frequently secondary to tumor, inflammation, degeneration, or trauma. Venous aneurysms of the neck can mimic masses. Differential diagnosis in an adult includes lymphadenopathy, laryngocele, thyroid nodule, congenital neck cyst, lipoma, lymphangioma, hemangioma, aneurysm of the thoracic duct, primary malignant tumor, and metastasis.^1,4

Saccular aneurysm of the external jugular vein is a rare clinical entity. It may be idiopathic, as in our case. The importance of our case lies in keeping this entity in mind in the differential diagnosis of cervical mass. Noninvasive imaging methods, especially MR angiography, play a key role in precise diagnosis.