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Objectives:
Pseudoaneurysms of the cervical venous system are rare occurrences typically in the internal jugular vein secondary to penetrating trauma. We report a case of a pseudoaneurysm of the external jugular vein as a result of blunt cervical trauma treated with surgical resection.
Methods :
A 32 year old otherwise healthy male presented to our emergency department complaining of a painless right-sided neck mass that increased in size over the preceding week. He reported a chokehold on his neck a week prior to presentation while playing with his young nephew and noted that the mass also increased in size on Valsalva maneuver (Figure 1a). On examination a soft, non-tender, compressible mass was easily palpated with no associated bruit or pulsatility. Cervical ultrasound was negative for any soft tissue pathology but demonstrated a superficial venous pseudoaneurysm (Figure 1b and c). CT venography demonstrated a 2.5x 2.2 cm pseudoaneurysm of the external jugular vein (EJ) with otherwise normal cervical vasculature (Figure 2 a-c). Attempts to control the pseudoaneurysm with manual pressure were unsuccessful, and surgical treatment was pursued given the recent increase in size.
Results:
Intraoperatively, a small longitudinal cervical incision was employed to obtain proximal and distal control of the EJ vein and its tributaries (Fig 3a). A posterior hole in the EJ vein was found to be communicating with the surrounding tissue as the contributing source of the pseudoaneurysm (Fig 3b). This segment was excised and the branches ligated (Fig 3c). Post-operatively, he had no further swelling and was discharged home. At three-month follow-up he had a well-healed incision with no further neck swelling.
Conclusion
Cervical venous pseudoaneurysm is a rare clinical entity in the differential diagnosis of a superficial neck mass. Long-term complications are rarely seen, but surgical treatment is warranted for rupture, continued expansion, fistulization and cosmesis.