Dysphagia because of unilateral internal jugular vein phlebectasia in an infant

Area of Science:

• Vascular Surgery
• Pediatric Surgery
• Vascular Malformations

Background:

• Phlebectasia of the internal jugular vein is a rare congenital anomaly presenting as neck swelling in children.
• Most cases are asymptomatic and managed conservatively due to concerns about intracranial pressure following surgical intervention.
• This condition, while benign, can occasionally cause significant symptoms like dysphagia.

Observation:

• A 7-month-old male infant presented with a large right internal jugular vein phlebectasia causing dysphagia.
• Contrast-enhanced computed tomography with 3-D reconstruction was utilized for precise pre-operative anatomical delineation.
• The phlebectasia was found to be covered by a fibrofatty pseudocapsule, facilitating surgical handling.

Findings:

• Surgical excision of the large internal jugular vein phlebectasia was performed using a cervico-thoracic approach.
• Postoperative recovery showed complete amelioration of the patient's dysphagia.
• The excised phlebectasia was not friable, contrary to common assumptions, and was easily removed due to its pseudocapsule.

Implications:

• This case demonstrates that surgical excision is a viable and effective treatment option for symptomatic internal jugular vein phlebectasia in children.
• Pre-operative imaging is crucial for planning the surgical approach and understanding the extent of the anomaly.
• The findings challenge the notion that such lesions are inherently friable and difficult to excise, suggesting a potentially broader application of surgical management.