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Venous malformation arising from external jugular vein- A case report

Dr Rakesh Sharma, Associate Professor, Government medical college, Kathua.

Abstract-

External jugular venous malformations are pretty rare an entity. They usually present as isolated neck masses in
adults. Very few case reports have been described in literature. Treatment is sought on account of swelling for
cosmetic reasons. These distinct clinical entities may be optimally treated with surgical excision with minimal

morbidity. Herein I report a rare case of venous malformation arising from the right external jugular vein excised
surgically with no recurrence.
Introduction

Venous malformations may present as isolated neck masses in adults. These venous mal- formations arising from the
external jugular vein are very rare. Sclerotherapy is the popular treatment for cervicofacial malformations. The major
complications of sclerotherapy include skin necrosis, residual lesions, skin pigmentation, peripheral nerve palsies and

hypotensive crisis, as well as fatalities such as cardiac arrest and pulmonary emboli. However venous malformations
may be easily and optimally treated with surgical excision without any resultant morbidities. In this case we opted for
surgical excision.

Case report
A 48 years old female presented to the with complaint of swelling on the right side of neck since past five years. The
swelling had been progressively increasing in size. However there was no pain, fever or any other constitutional

symptoms. On physical examination, there was a 4cm soft, non tender mass in the right posterior triangle of the neck. It
was mobile and not attached to overlying skin or underlying muscle. No pulsation or thrill was demonstrated. There
was no other palpable mass or lymph node detected in the rest of the neck. Indirect laryngeal mirror examination

revealed a normal study. Ultrasonography howed an elliptical, solid, hypoechoic 34mm noncalcified mass that was
inseparable from the (right) external jugular vein. Computerized Tomography with angiography showed a soft tissue
density lesion 34* 18 mm in lower third of right side of the neck. There was no evidence of calcification. Sonography

and CT Angiography findings were compatible with the diagnosis of a slow-flow VM intimately connected with the
external jugular vein which demonstrated normal flow. Intra- operatively, venous malformation arising from the
external jugular vein was identified. A single feeding vessel was identified which was ligated and lesion completely

excised. Macroscopically, the excised lesion was a well- circumscribed and brown in color. Microscopically, the lesion
was composed of vascular spaces with a thin wall and lined by a layer of endothelium. The histopathological analysis
was in sync with venous malformation.

Discussion
The nomenclature of cutaneous vascular lesions in the past had always been perplexing, with no consensus until
Corresponding Author 1982, when Mulliken and Glowacki proposed their revolutionary classification scheme. This scheme, based on
Dr. Yangchen Dolma
endothelial cellular characteristics, correlates well with the biologic behavior of such cutaneous vascular lesions.
Assistant Professor, Department of community Medicine, Government Medical
College, Kathua

The Integrated Indian Journal of Cancer Sciences