Left Internal Jugular Vein Phlebectasia: Sporadic Presentation of Rare Disease—A Case Report

Abstract

Jugular vein phlebectasia (JVP) refers to fusiform, non-tortuous distention of a portion of vein, two to three times its usual size, first addressed by Harris in 1928. It is classically considered a rare benign structural anomaly, with only 247 cases reported. Internal jugular vein is affected in most cases of phlebectasia in head and neck region; it is frequently observed on right side probably due to favorable anatomical features such as larger right internal jugular bulbs, shorter course of right brachiocephalic vein, direct emptying into the superior vena cava, and the close proximity of right innominate vein to the apical pleura, therefore risking the right IJV as the intrathoracic pressure rises. It presents as a soft, compressible, and painless swelling over the lateral neck, briefly emerging with augmented intrathoracic pressure, like during coughing, straining or performing Valsalva. Treatment strategy is usually conservative. A 7-year-old male child presented with complaint of intermittent left sided neck swelling, noticed by parents when the child cries or shouts and disappears afterward. X-ray neck was done which came normal with no unusual air shadow. CT scan reported fusiform ectasia of left internal jugular vein in neck at the level of thyroid gland, about 1.6 × 2.7 × 4.8 cm in size with the diagnosis of “phlebectasia.” This case report unveils an extremely rare occurrence of phlebectasia that typically affects children and on the right side of the neck, by presenting on the left side, highlighting the unpredictable nature of this already uncommon condition in Asia.