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Management Of Internal Jugular Venous Aneurysm
Caroline Goel, MD, Barath Badrinathan, MD.
Emory University, Atlanta, GA, USA.
DEMOGRAPHICS Aneurysms of the internal jugular vein are rare and typically asymptomatic. Primary venous aneurysm is described as an isolated venous dilatation, communicating with a normal size venous segment, not associated with prior trauma. They typically present as a palpable neck mass. We present a case of a symptomatic internal jugular venous aneurysm and discuss the surgical management of this patient’s disease.
HISTORY The patient is a 39-year-old woman with hypothyroidism and no past surgical history who presented with burning, throbbing neck pain, exacerbated by stress and tension. She endorsed a “whooshing” sensation in her right ear. On physical exam, she was noted to have right neck fullness, tenderness to palpation, and a neck bruit on auscultation. She underwent CT of the neck which demonstrated a 2.85cm right internal jugular venous aneurysm.
PLAN Given the symptomatic nature of this patient’s aneurysm, we recommended open surgical repair. The internal jugular vein was exposed and mobilized. The common facial vein was ligated and the vagus nerve was identified and preserved. Dissection was extended until the vein was normal in size. The vein was clamped longitudinally, and the aneurysmal portion was plicated with prolene sutures using a Blalock stitch. After ensuring hemostasis, the surgical site was closed in multiple layers. The patient recovered without issue and was discharged on postoperative day one without anticoagulation. Follow-up duplex ultrasound did not demonstrate any associated thrombus. Her symptoms resolved completely.
DISCUSSION Internal jugular venous aneurysms (IJVA) are rare and often misdiagnosed. Due to potential morbidity, surgical management is considered for symptom relief and to reduce the risk of thrombosis or rupture. We present a case of a symptomatic aneurysm in a healthy surgical candidate who underwent successful plication of her aneurysm with excellent postoperative results. The exact cause of IJVA is unknown. Histopathologic studies suggest a degenerative etiology, through matrix metalloproteinase dysfunction or acquired by inflammation or mechanical stress. Thrombotic or rupture-related complications are rarely described. Owing to the rarity of IJVA, clinical treatment guidelines are lacking. Therefore, surgery is often recommended for symptom management. Further studies can enhance our current understanding of this disease.
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